Prestige Care Medical Aid Package

OAL Unlimited | From N$3,505/Month

With an unlimited hospital benefit, Prestige Care is the top of the medical aid ladder. As the most comprehensive medical aid package in the market, Prestige care offers the ultimate peace of mind for your health.

Hospital Benefit
Unlimited

Doctor Service
N$ 36, 800 per year

Optical Benefit
N$ 4, 800 per year

Dental Benefit
N$ 12, 400 per year

MONTHLY CONTRIBUTIONS
AGEINDIVIDUAL 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 - 253,5052,4601,6903,015 2,1501,4602,8351,9951,345 2,6751,9001,285
26 - 304,0952,8551,6903,5402,4551,4603,3152,3051,3453,1302,1751,285
31 - 354,4153,0601,6903,8452,6401,4603,5802,4701,3453,3752,3301,285
36 - 404,9803,6901,6904,3153,2051,4604,0052,9851,3453,7902,8201,285
41 - 455,4904,1101,6904,7553,5851,4604,4403,3401,3454,1953,1501,285
46 - 505,9754,6901,6905,1754,0751,4604,825 3,7901,3454,5853,6101,285
51 - 556,5355,0301,6905,6454,3551,460 5,2754,0601,3454,9903,8551,285
56 - 607,1255,5951,6906,1954,8401,4605,7804,5401,3455,4554,3001,285
61 - 657,8006,0101,6906,7605,2051,4606,3004,8601,3455,9554,5901,285
66+8,5256,5901,6907,4005,6951,4606,8805,3151,3456,5305,0451,285
HOSPITAL BENEFITSTARIFF %BENEFITS
TOTAL ALL-INCLUSIVE OVERALL ANNUAL LIMITUnlimited
HOSPITAL BENEFIT GROUP (Subject to clinical risk management protocols)Unlimited
Private hospital (Including medicines, materials, hospital apparatus and seven days Take-Out Medication)100%Unlimited
Accommodation in private wards100%N$ 45, 500 per family N$ 22, 300 per beneficiary
State hospitals (Including medicines, materials, hospital apparatus & seven days, Take-Out Medication)100%Unlimited
Sub-acute facility ward fees. (Admission in lieu of hospitalisation).100%
Consultations including treatment and services.225%
Blood transfusion100%
Radiology and Pathology100%
Physiotherapy.100%
Post Operative Extended Benefit (Following major surgery). Part of pre-authorisation and clinical protocols100%Following surgery limited to 6 weeks treatment or 12 sessions
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 protocols225%Unlimited
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.225%
MRI / CT / PET SCAN / BONE DENSITY (In- and Out-of-Hospital)N$ 65, 600 per family
N$ 32, 900 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$ 150, 000 per family
N$ 100, 000 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.225%Part of the sub-limit
DENTAL AND ORAL SURGERYN$ 25, 300 per family
N$ 16, 800 per beneficiary
Admission100%Part of the sub-limit
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.225%
EYE SURGERYPart of the Overall Annual Limit
Admission100%Unlimited
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.225%
Excimer laser and radial keratotomy only after two years membership. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols. N$ 37, 500 per family
N$ 25, 000 per beneficiary
RECONSTRUCTIVE SURGERY N$ 29, 100 per family
N$ 19, 400 per beneficiary
Admission100%Part of the sub-limit
Reconstructive Surgery - After two years membership, including breast reductions. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols225%
ALTERNATIVE SERVICES N$ 50, 600 per family
N$ 35, 000 per beneficiary
In- and Out-of-Hospital Benefit including occupational therapy, private nursing, palliative care (end stage terminal diseases) and frail care100%Part of the sub-limit
MENTAL HEALTH21 days per beneficiary
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 limits.100% 21 days per beneficiary
INTERNAL PROSTHESISSubject to RHMAF protocol
nternal prosthesis - example: knee / hip / pacemakers. Part of pre-authorisation and clinical risk management protocols100%Subject to RHMAF protocol
TRAUMA TREATMENTPart of the Overall Annual Limit
Oncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (In hospital).225%Unlimited
Oncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (Out of hospital).180%
Motor Vehicle Accidents (MVA)225%
HEALTH IS VITALPart of the Overall Annual Limit
Hospital and treatment.100%Unlimited
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$ 36, 800 per family
N$ 18, 300 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 reportsAgreed Tariff
Pharmacist and telephone consultations100%
General Practitioner / primary and specialist procedures in rooms including equipment, materials and injections.100%
Psychiatric treatment.100%
Radiology100%
Pathology100%
PARAMEDICAL SERVICES N$ 19, 600 per family
N$ 9, 800 per beneficiary
Including physiotherapy, social workers, speech therapy, audiology, acousticians, dieticians, occupational therapy, clinical psychology, biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc100%Part of the sub-limit
Auxiliary services - Biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc.100%
EXTERNAL PROSTHESIS AND MEDICAL APPLIANCESN$ 87, 500 per family
N$ 43, 800 per beneficiary
Prosthesis external - Artificial arms / legs / eyes every two years. Part of pre-authorisation and approval.100% of cost Part of the sub-limit
Special external medical appliances - Wheelchairs every three years; hearing aids apparatus every two years. Part of pre-authorisation and approval.90% of cost
General external medical appliances - Including glucometers, blood pressure monitors, stockings, braces etc. Part of pre-authorisation and approval. 80% of cost
OPTICAL BENEFIT N$ 13, 300 per family
N$ 5, 800 per beneficiary
Eye tests.100%Part of the sub-limit
Lenses / contact lenses100%
Frames, once every two years100%N$ 2, 300 per beneficiary
DENTISTRY BENEFITN$ 37, 700 per family
N$ 17, 900 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%
MEDICATION BENEFITN$ 53, 600 per family
N$ 23, 900 per beneficiary
Acute medication - Preferred and non-preferred.80% NRPN$ 20, 700 per family
N$ 8, 300 per beneficiary
Pharmacy initiated therapy and OTC medication. Maximum of N$ 200 per script.80% NRPN$ 1, 800 per beneficiary
Homeopathic medication.80% NRPPart of Acute Medication sub-limit
Primary health scripts80% NRP
Chronic medication - Preferred and non-preferred. Preferred 90% Non-preferred 80%N$ 32, 900 per family N$ 15, 600 per beneficiary
EXTENDED MEDICATION BENEFITN$ 137, 400 per family
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.Part of the sub-limit
Preferred medication90% NRP
Non preferred medication80% NRP
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).80% NRP
MATERNITY BENEFITSTARIFF %BENEFITS
MATERNITY AND BABY BENEFIT Unlimited
Gynaecology / obstetric - In hospital. 225%Normal birth / Caesarean Section
Gynaecology / obstetric - Out of hospital.100%Unlimited
Maternity scans.100%2 scans per beneficiary
Antenatal visits.100%12 visits per beneficiary
Amniocentesis - AHB excluded.100%Unlimited
Neonatal ICU / ward fees.100%
Paediatrician visits - Postnatal.100%2 visits per family, per annum
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).100% 6 weeks treatment or 12 sessions
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.100% of costN$ 5, 700 per family
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$ 5, 600
Adult Dependant N$ 4, 200
Child Dependant N$ 1, 900
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 rejections.100% 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