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.

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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.