Premiere Care Medical Aid Package

OAL Unlimited at State Hospital | Per family N$ 368,000 at Private Hospital | From N$2,250/Month

Premiere Care is the start of your medical aid journey; the medical aid essential for you as you start your personal journey. Premier Care gives you access to hospital, day to day and complimentary benefits.

Hospital Benefit
Unlimited at State facility

Doctor Service
N$ 9.300 per year

Optical Benefit
N$ 6.900 per year

Dental Benefit
N$ 5.300 per year

MONTHLY CONTRIBUTIONS
IncomeINDIVIDUAL RATES
9 members or less
GROUP RATE 1
For groups with 10 - 49 Principal Members
GROUP RATE 2
For groups with 50 - 249 Principal Members
GROUP RATE 3
For groups with 250 and more Principal Members
Principal MemberAdult DependantChild DependantPrincipal MemberAdult DependantChild DependantPrincipal MemberAdult DependantChild DependantPrincipal MemberAdult DependantChild Dependant
0 - 1, 500615425185530380165495340160460325155
1, 501 - 3, 000685485205570425190540395170515390160
3, 001 - 6, 000805565265685480230645465190625440190
6, 001+1,110765345945680285890645270855605265
HOSPITAL BENEFITSTARIFF %BENEFITS
TOTAL ALL-INCLUSIVE OVERALL ANNUAL LIMITUnlimited at State Facilities
HOSPITAL BENEFIT GROUP (Subject to clinical risk management protocols)N$ 368, 000 per family
Private hospital (Approved surgical and medical admissions only) (Including medicines, materials, hospital apparatus and seven days Take-Out Medication).100%No benefit
Accommodation in private wards.100%No benefit
State hospitals (Approved surgical and medical admissions only) (Including medicines, materials, hospital apparatus & seven days, Take-Out Medication).100%Part of the Overall Annual Limit
Sub-acute facility ward fees. (Admission in lieu of hospitalisation).100%Part of the sub-limit in a private hospital and unlimited in State facilities
Consultations including treatment and services.100%Part of the Overall Annual Limit
Blood transfusion100%
Radiology and Pathology.100%
Physiotherapy100%
Post Operative Extended Benefit (Following major surgery). Part of pre-authorisation and clinical protocols.100%No benefit
SURGICAL PROCEDURES DONE IN ROOMS / UNATTACHED THEATRESPart of the Overall Annual Limit
Doctors’ rooms - Selective surgical and endoscopic procedures, circumcisions. Inclusive benefit - Admissions, surgery, treatment and services. Part of pre-authorisation and clinical protocols100%Part of the Overall Annual Limit
Admission to unattached operating theatres and sub-acute facilities100%
Selective surgical and endoscopic procedures, circumcisions - unattached operating theatres, doctors’ rooms and subacute facilities. Including surgery, treatment and services. Part of pre-authorisation and clinical protocols.100%
MRI / CT / PET SCAN / BONE DENSITY (In- and Out-of-Hospital)N$ 8, 300 per family
N$ 4, 200 per beneficiary
In- and Out-of-Hospital Benefit. Part of pre-authorisation and clinical protocols. 100% Part of the sub-limit
MAXILLOFACIAL AND DENTAL SURGERY (In- and Out-of-Hospital)N$ 16, 300 per family
N$ 18, 700 per beneficiary
Non-elective maxillofacial / oral surgery - Trauma, including dental extractions of more than three teeth or multiple fillings in children under the age of ten and disabled dependants / removal of impacted wisdom teeth. (All-inclusive benefit - surgery, treatment and services). Part of clinical protocols.100%Part of the sub-limit
DENTAL AND ORAL SURGERYNo benefit
AdmissionNo benefit
Elective dental and oral surgery, including dental implant surgery, excluding the cost of the dental implant. (All-inclusive benefit - surgery, treatment and services). Part of clinical protocols and applicable Medical Aid Fund Rules.No benefit
EYE SURGERYN$ 54, 000 per family
Admission100%Part of the Overall Annual Limit
Including cataract surgery, glaucoma surgery, eye muscle surgery, corneal surgery, eye removal, vitreo-retinal surgery, etc. (Allinclusive benefit - admission, surgery, treatment and services). Part of clinical protocols and twelve month waiting period.100%
Excimer laser and radial keratotomy only after two years membership. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols.No benefit
RECONSTRUCTIVE SURGERY No benefit
Admission100%No benefit
Reconstructive Surgery - After two years membership, including breast reductions. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols180%
ALTERNATIVE SERVICES No benefit
In- and Out-of-Hospital Benefit including occupational therapy, private nursing, palliative care (end stage terminal diseases) and frail care.100%No benefit
MENTAL HEALTH
In- and Out-of-Hospital treatment and services, including psychiatric hospital accommodation, treatment and services, alcohol & drug addiction, addiction therapy and related pathology. (Part of treatment plan protocols). Excluding auxiliary services, which is part of the day to day benefit limits100%State facilities only No benefit in private hospitals
INTERNAL PROSTHESIS
Internal prosthesis - example: knee / hip / pacemakers. Part of pre-authorisation and clinical risk management protocols.100%State facilities only No benefit in private hospitals
TRAUMA TREATMENT
Oncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (In hospital).100%State facilities only No benefit in private hospitals
Oncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (Out of hospital).180%
Motor Vehicle Accidents (MVA)180%
HEALTH IS VITALPart of the Overall Annual Limit
Hospital and treatment.100%Part of the Overall Annual Limit
HIV / AIDS visits.100%N$ 3, 500 per family
HIV / AIDS pathology100%N$ 12, 700 per family
HIV / AIDS medication.100% NRPN$ 41, 600 per family
HIV counselling100%N$ 4, 900 per family
DAY TO DAY BENEFITSTARIFF %BENEFITS
PROFESSIONAL SERVICESN$ 9, 300 per family
N$ 4, 700 per beneficiary
General Practitioner, specialist consultations and primary healthcare consultations.100% Part of Professional Service limit
General Practitioner and specialist administration fee for chronic patient applications and medical reportsNo benefit
Pharmacist and telephone consultations.100%Part of Professional Service limit
General Practitioner / primary and specialist procedures in rooms including equipment, materials and injections100%
Psychiatric treatmentNo benefit
Radiology100% Part of Professional Service limit
Pathology100%
PARAMEDICAL SERVICESNo benefit
Including physiotherapy, social workers, speech therapy, audiology, acousticians, dieticians, occupational therapy, clinical psychology, biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc. No benefit
Auxiliary services - Biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc
EXTERNAL PROSTHESIS AND MEDICAL APPLIANCESNo benefit
Prosthesis external - Artificial arms / legs / eyes every two years. Part of pre-authorisation and approval. No benefit
Special external medical appliances - Wheelchairs every three years; hearing aids apparatus every two years. Part of pre-authorisation and approval.
General external medical appliances - Including glucometers, blood pressure monitors, stockings, braces etc. Part of pre-authorisation and approval.
OPTICAL BENEFIT N$ 950 per family
N$ 630 per beneficiary
Eye tests.100%Part of the sub-limit
Lenses / contact lenses100%
Frames, once every two years100%
DENTISTRY BENEFITN$ 5, 300 per family
N$ 2, 600 per beneficiary
Conservative dentistry - Fillings, extractions and oral hygiene100%Part of the sub-limit
Special dentistry - Dental implants, crowns, bridges, dentures and orthodontic treatments. Part of preauthorisation and approved treatment plan. 100% Plastic dentures every 2 years
MEDICATION BENEFITN$ 6, 900 per family
N$ 3, 400 per beneficiary
Acute medication - Preferred and non-preferred.100% NRPPart of the sub-limit
Pharmacy initiated therapy and OTC medication. Maximum of N$ 180 per script. No benefit
Homeopathic medication.
Primary health scripts100% NRPPart of the sub-limit
Chronic medication - Preferred and non-preferred.100% NRP
EXTENDED MEDICATION BENEFITNo benefit
In- and Out-of-Hospital: Extended Medication Benefit cover for oncology, renal care and organ transplant (excluding chemo and radiation therapy and treatment). Part of registration and treatment plan protocols. Chronic medication related to severe illness conditions may be extended to this benefit, where Medication Benefit has been depleted. Part of registration and treatment plan protocols.No benefit
Preferred medication
Non preferred medication
Specialised medicines such as biologicals (In terms of defined conditions and part of managed care protocols - excluding off-label medication. In- and Out-of-Hospital).
MATERNITY BENEFITSTARIFF %BENEFITS
MATERNITY AND BABY BENEFIT Unlimited
Gynaecology / obstetric - In hospital. 180%Part of the sub-limit in private hospitals.
Unlimited in State facilities
Gynaecology / obstetric - Out of hospital.100%
Maternity scans.100%2 scans per beneficiary
Antenatal visits.100%12 visits per beneficiary
Amniocentesis - AHB excluded.100%Part of the Overall Annual Limit
Neonatal ICU / ward fees.100%
Paediatrician visits - Postnatal.100%
WELLNESS BENEFITSTARIFF %BENEFITS
WELLNESS MANAGEMENTN$ 10, 000 per family
PREVENTATIVE HEALTH BENEFIT (Members may earn benefit rewards for participation)Part of Wellness Management
Blood sugar test, cholesterol test, BMI and blood pressure measurement100%1 per beneficiary, per annum
Dental examinations. 100%
Mammogram (inclusive DEXA bone density scan) - Radiology.100%1 per female, over 40 years, per annum
Pap smear. Pathology including general practitioner / gynaecology visits. 100%1 per female, over 20 years, per annum
HIV test all ages100%1 per beneficiary
Prostate screening. Pathology prostate specific antigen test100%1 screen per male beneficiary over the age of 50 years, per annum
Chronic disease wellness management - Follow-up test in the management of selective chronic diseases including: chronic renal failure, diabetes mellitus type 1 & 2, HIV / Aids, hyperlipidemia and multiple sclerosis (MS) - Excluding specialised radiology, which will be payable from the available MRI / CT Benefit100%Part of Wellness Management sub-limit. In accordance with an approved clinical treatment plan, for routine follow-up tests when required.
WELLNESS REWARD - BENEFIT WALLET ALLOCATION FOR PREVENTATIVE HEALTH BEHAVIOURBenefit Wallet Reward Points
Blood sugar test, cholesterol test, BMI and blood pressure measurement.100
Dental examinations100
Mammogram (inclusive DEXA bone density scan) - Radiology150
Pap smear. Pathology including general practitioner / gynaecology visits. 100
HIV test, all ages.100
Prostate screening. Pathology prostate specific antigen test.150
Chronic medication compliance150
IMMUNISATION (Vaccines only)Part of Wellness Management
Flu vaccines100% NRP1 flu vaccination per beneficiary, per annum
Pneumococcal vaccine100% NRP 1 per beneficiary, over 65 years, per annum
Baby immunisations 0 - 7 years.100% NRP Vaccinations for children 0 - 7 years
HPV vaccine - Females between 9 - 30 years100% NRP 3 injections during the course of a year, once per lifetime
PREVENTATIVE REHABILITATION TREATMENTPart of Preventative Benefit sub-limit
Orthopaedic rehabilitation and treatment relating to Chronic disease management - Part of approved treatment plans, pre-authorisation and clinical risk management. (Note - Biokinetic treatment plans for orthopaedic rehabilitation and chronic members disease management - may first be approved and payable from the normal day to day Paramedical Services Benefit - additional required treatment sessions may be considered for approval from the Preventative Rehabilitation Treatment Benefit - subject to available treatment sessions).No benefit
COMPLIMENTARYTARIFF %BENEFITS
PREMIUM PROTECTIONPeriod
Covers monthly Medical Aid Fund contributions on the life of the Principal Member. 100%3 months
TRAVEL AND ACCOMMODATION BENEFIT
Transport cost when referred for specialist services not available in the area of residence.No benefit
BENEFIT REWARDS Low claiming threshold levels
  1. Each dependant is allocated with a threshold value per annum. Should you claim less than your threshold value as at 31 December of each year, the remaining balance of your threshold may be transferred to your Benefit Wallet. (The balance is transferred after 4 months to allow for the run off of medical claims incurred in the previous year).
  2. Members participating in wellness day initiatives and preventative testing may earn additional Benefit Wallet rewards, this includes early registration on the maternity program and additional rewards for normal deliveries.
  3. 80% of unused benefits in the Benefit Builder may be transferred annually to the Benefit Wallet (The balance is transferred after 4 months to allow for the run off of medical claims incurred in the previous year).
Principal Member N$ 700
Adult Dependant N$ 450
Child Dependant N$ 200
BENEFIT WALLET
Accumulated Benefit Wallet benefits may be used for purchasing of medical treatment and services in terms of the Medical Aid Funds Act, provided that the member pays first and claims back from the Benefit Wallet within the 4 month claiming period. Allow Provider payments for excess of Benefit and tariff rejections100% of costSubject to availability of Benefit Wallet benefits, medical treatment and services obtained from a registered medical facility
LONGSTANDING MEMBERSHIP REWARDSGroup Rate 1 Contributions
A member who is 65 or older and has been with the Fund for more than 20 years may qualify for Group Rate 1 contributionProvided the member is not already on a Group Rate status
INTERNATIONAL RESCUE ME & ASSISTANCE (In addition to the Overall Annual Limit)N$ 10, 000, 000 per family
Emergency evacuation and ambulance services (air or road).100%Terms and conditions
Repatriation (SADC) - Return after emergency or return of mortal remains.100%Related to emergency evacuation
Medical treatment100%Terms and conditions
Evacuation, repatriation, return of children.100%Terms and conditions