Benefit
Builder
We acknowledge that each individual person’s healthcare needs are unique, and that his/her health status may change at any time during the year. For this reason we offer you a plethora of medical benefits, which you may buy, in order to extend your cover.
Benefit Builder - Available on these product options
| Elite Care | Prestige Care | Status Care | Caliber Care | Esteem Care |
| Evolve Care | Premiere Care |
| Annual Contributions | Monthly Contributions | |
|---|---|---|
| Benefit Builder – Options | ||
| Family Benefit Builder N$ 3, 000 | N$ 2, 700 | N$ 225 |
| Family Benefit Builder N$ 5, 000 | N$ 4, 500 | N$ 375 |
| Family Benefit Builder N$ 7, 000 | N$ 6, 300 | N$ 525 |
| Family Benefit Builder N$ 10, 000 | N$ 9, 000 | N$ 750 |
| Family Benefit Builder N$ 12, 000 | N$ 10, 800 | N$ 900 |
| Family Benefit Builder N$ 15, 000 | N$ 13, 500 | N$ 1, 125 |
| Family Benefit Builder N$ 17, 000 | N$ 15, 300 | N$ 1, 275 |
| Family Benefit Builder N$ 20, 000 | N$ 18, 000 | N$ 1, 500 |
| Family Benefit Builder N$ 22, 000 | N$ 19, 800 | N$ 1, 650 |
| Family Benefit Builder N$ 25, 000 | N$ 22, 500 | N$ 1, 875 |
Benefit Builder Cover – Day-to-Day benefits
| Tariff % | Benefits | |
|---|---|---|
| Day-to-Day Benefits | ||
| Medical Services | ||
| General Practitioner, specialist consultations and primary healthcare consultations. | 100% | Part of the family limit |
| General Practitioner and Specialist administration fee for chronic patient applications and medical reports. | ||
| Pharmacist and telephone consultations. | ||
| General Practitioner / primary and specialist procedures in rooms including equipment, materials and injections. | ||
| Psychiatric treatment. | ||
| Radiology and Pathology. | ||
| Alcohol and drug addiction and addiction therapy and related pathology. Part of treatment plan protocols. | ||
| Paramedical services including physiotherapy, social workers, speech therapy, audiology, acousticians, dietitians, occupational therapy, clinical psychology, biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc. |
||
| Transport and accommodation | ||
| General Practitioner, specialist consultations and primary healthcare consultations. | 100% | Part of the family limit |
| Medication | ||
| Acute medication (Non-preferred and preferred medication) including homeopathic medication and primary health scripts. |
100% NRP | Part of the family limit |
| Pharmacy initiated therapy and OTC medication. Maximum of N$ 200 per script. | 100% NRP | |
| Chronic medication (Preferred). | 100% NRP | |
| Chronic medication (Non-preferred). | 100% NRP | |
| Optical Benefit | ||
| Lenses / contact lenses. | 100% | Part of the family limit |
| Frames. | ||
| Eye tests. | ||
| Dentistry Benefit | ||
| Conservative dentistry and specialised dentistry including – Fillings, extractions and oral hygiene, dental implants, crowns, bridges, dentures and orthodontic treatment. |
100% | Part of the family limit |
Benefit Builder Cover – Hospital Benefit
| Tariff % | Benefits | |
|---|---|---|
| Hospital Benefits | ||
| MRI / CT / Pet Scan / Bone Density (In – and out-of-hospital) | ||
| In- and Out-of-Hospital Benefit. Part of pre-authorisation and clinical protocols. | 100% | Part of the family limit |
| Maxillofacial and dental surgery (In – and out-of-hospital) | ||
| 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 family limit |
| Dental and Oral Surgery | ||
| 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. |
100% | Part of the family limit |
| Eye Surgery | ||
| Excimer laser and radial keratotomy only after two years membership. (All-inclusive benefit – admissions, surgery, treatment and services). Part of clinical protocols. |
100% | Part of the family limit |
| Reconstructive Surgery | ||
| Reconstructive Surgery – After two years membership, including breast reductions. (All-inclusive benefit – admissions, surgery, treatment and services). Part of clinical protocols. |
100% | Part of the family limit |
| Alternative Services | ||
| In- and Out-of-Hospital Benefit including occupational therapy, private nursing, palliative care (end stage terminal diseases) and frail care. |
100% | Part of the family limit |
| 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 limits. |
100% | Part of the family limit |
| Health is vital | ||
| HIV / AIDS visits. | 100% | Part of the family limit |
| HIV / AIDS pathology. | ||
| HIV / AIDS medication. | ||
| HIV counselling. | ||