product guide 2022

PRODUCT GUIDE 2022

01

02

07

14

19

24

31

36

41

42

PRODUCT OPTIONS

PRESTIGE CARE

STATUS CARE

CALIBER CARE

ESTEEM CARE

BENEFIT BUILDERS

PREMIERE CARE

BENEFIT WALLET

PREMIERE CARE - NETWORK

QUESTIONS & ANSWERS

12 MOBILE APP

13 BENEFIT TIPS

26 EVOLVE CARE

44 CONTACT DETAILS

1Renaissance Health Medical Aid Fund Product Guide 2022

YOUR PRODUCT OPTION REVOLVES AROUND YOUR HEALTHCARE NEEDS. SO IT IS IMPORTANT THAT YOU BECOME FAMILIAR WITH YOUR OPTION.

Choose a Product that will fulfill the healthcare needs for you and your family at a monthly contribution that you can afford. Renaissance Health offers a range of Product Options from Elite Care, that provides the most comprehensive cover, to Premiere Care, that provides for primary healthcare. Each Option has been tailored to cater for specific healthcare needs and your benefits are determined by the Option that you choose. Therefore you need to assess your healthcare needs and become familiar with the benefits available to you by carefully reading the brochure.

INCLUSIVE BENEFITS IN PRODUCT OPTIONS.

The following benefits are inclusive benefits within the Renaissance Options: Emergency evacuation, Repatriation, Premium protection (should the Principal Member die, the monthly contribution may be covered for three months), international and SADC medical emergency evacuation and a Benefit Wallet. Renaissance provides comprehensive cover to its Members.

WELLNESS MANAGEMENT BENEFITS - PREVENTION IS BETTER THAN CURE.

Many illnesses and problematic conditions can be prevented and treated before they become a serious health risk. We advocate that prevention is better than cure and have provided for extensive wellness benefits to determine health risks that we will actively manage. Find out more about your Wellness Management Benefits on each Product page.

SHOULD YOU NEED MORE BENEFITS DURING THE YEAR.

In that case, Benefit Builders are your answer. Refer to page 24 on Benefit Builders to find out how you can top up your benefits during a benefit year. (What you don’t use – you won’t lose - we may transfer 80% of the unused Benefit Builder benefits to your Benefit Wallet in the following year).

SHOULD YOU NEED TO MAKE CHANGES TO YOUR PRODUCT OPTION.

If you need more benefits or less benefits, you have the opportunity to change your Product Option from the 1st of December of every year, until the 31st of January of the following year. Speak to your HR manager, visit one of our offices or visit our website at www.rmanam.com to obtain an Option Transfer form.

PRODUCT OPTIONS

OV

ERALL A

NN

UA

L LIMIT

Per family: N

$ 1, 165, 500 Per beneficiary: N

$ 787, 500

BENEFITWALLET

COMPLEMENTARY BENEFITS

WELLNESS BENEFITS

DAY-TO-DAY BENEFITS

HIV BENEFITS

PRIVATE HOSPITAL BENEFITS

EVOLVE CARE

OV

ERALL A

NN

UA

L LIMIT

Unlim

ited at State Hospitals

Per family: N

$ 368, 000 at Private H

ospitals

BENEFITWALLET


WELLNESS BENEFITS

DAY-TO-DAY BENEFITS

HIV BENEFITS


PREMIERECARE

OV

ERALL A

NN

UA

L LIMIT

Unlim

ited

BENEFITWALLET


WELLNESS BENEFITS

DAY-TO-DAY BENEFITS

HIV BENEFITS


STATUSCARE

BENEFITBUILDERS

INCLUSIVE BASE BENEFIT BUILDER

OV

ERALL A

NN

UA

L LIMIT

Per family: N


$ 2, 000, 000

BENEFITWALLET


WELLNESS BENEFITS

DAY-TO-DAY BENEFITS

HIV BENEFITS


CALIBER CARE

BENEFITBUILDERS


OV

ERALL A

NN

UA

L LIMIT

Per family: N


$ 1, 103, 000

BENEFITBUILDERS

BENEFITWALLET


WELLNESS BENEFITS

DAY-TO-DAY BENEFITS

HIV BENEFITS


ESTEEMCARE


OV

ER

ALL A

NN

UA

L LIMIT

Unlim

ited

PRESTIGE CARE

BENEFITWALLET


WELLNESS BENEFITS

DAY-TO-DAY BENEFITS

HIV BENEFITS


BENEFITBUILDERS


OV

ERALL A

NN

UA

L LIMIT

Unlim

ited at State Hospitals

Per family: N

$ 368, 000 at Private H

ospitals

BENEFITWALLET


WELLNESS BENEFITS

DAY-TO-DAY BENEFITS

HIV BENEFITS


PREMIERECARE

NETWORK

2 PRESTIGE CARE

AGE

INDIVIDUAL RATES9 members or less

GROUP RATE 1For groups with 10 - 49

Principal Members


Principal Members

GROUP RATE 3For groups with 250 and more

Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 25 3,905 2,735 1,880 3,355 2,390 1,625 3,160 2,220 1,495 2,975 2,115 1,430

26 - 30 4,560 3,180 1,880 3,940 2,730 1,625 3,690 2,565 1,495 3,485 2,425 1,430

31 - 35 4,915 3,410 1,880 4,280 2,940 1,625 3,985 2,750 1,495 3,755 2,595 1,430

36 - 40 5,545 4,105 1,880 4,805 3,570 1,625 4,455 3,325 1,495 4,215 3,135 1,430

41 - 45 6,110 4,575 1,880 5,295 3,990 1,625 4,940 3,715 1,495 4,670 3,505 1,430

46 - 50 6,650 5,220 1,880 5,760 4,535 1,625 5,370 4,215 1,495 5,100 4,015 1,430

51 - 55 7,275 5,595 1,880 6,285 4,845 1,625 5,870 4,520 1,495 5,555 4,290 1,430

56 - 60 7,930 6,225 1,880 6,895 5,390 1,625 6,435 5,055 1,495 6,070 4,785 1,430

61 - 65 8,680 6,690 1,880 7,525 5,795 1,625 7,015 5,410 1,495 6,630 5,105 1,430

66+ 9,490 7,335 1,880 8,240 6,335 1,625 7,655 5,915 1,495 7,270 5,615 1,430

MONTHLY CONTRIBUTIONS

OVERALL ANNUAL LIMIT Unlimited

PRESTIGE CARE

OPTIONAL BENEFITS

CORE

BEN

EFITS

LIFESTYLE REWARDS

HOSPITAL BENEFITS

Peace of mind with superior in-hospital

benefits for the whole family.

DAY-TO-DAY BENEFITS

Extensive cover for your day-to-day medical needs.

WELLNESS BENEFITS

Prevent life threatening conditions from becoming

severe and use your Wellness Benefits for

early detection.

COMPLEMENTARYBENEFITS

Make your Out-of-Hospital Benefits go further by providing extra cover and peace of mind.

BENEFIT WALLET

Receive benefit rewards which you can use to

cover additional medical costs.

BASE BENEFIT BUILDER

Inclusive medical benefits which you can use to


OPTIONAL BENEFIT BUILDERS

Customise your benefits for when and

if you need them.

See page 24.

EXTRA BENEFITS

3PRESTIGE CARE

TARIFF % BENEFITSHOSPITAL BENEFITSTOTAL ALL-INCLUSIVE OVERALL ANNUAL LIMIT Unlimited

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 wards. 100% 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 transfusion. 100%

Radiology and Pathology. 100%

Physiotherapy. 100%

Post-Operative Extended Benefit (Following major surgery). Part of pre-authorisation and clinical protocols. 100% Following surgery limited to 6 weeks treatment or 12 sessions

DBC (Musculoskeletal rehabilitaion in prevention of lumbar-spinal surgery) Agreed Tariff As per DBC protocol and treatment plan

SURGICAL PROCEDURES DONE IN ROOMS / UNATTACHED THEATRES Unlimited

Doctors’ rooms - Selective surgical and endoscopic procedures, circumcisions. Inclusive benefit - Admissions, surgery, treatment and services. Part of pre-authorisation and clinical protocols.

225%

UnlimitedAdmission to unattached operating theatres and sub-acute facilities. 100%

Selective surgical and endoscopic procedures, circumcisions - unattached operating theatres, doctors’ rooms and sub-acute 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


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


Admission. 100%

Part of the sub-limitElective 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 SURGERY Unlimited

Admission. 100%

UnlimitedIncluding cataract surgery, glaucoma surgery, eye muscle surgery, corneal surgery, eye removal, vitreo-retinal surgery, etc. (All-inclusive benefit - admission, surgery, treatment and services). Part of clinical protocols and after 1-year membership. 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


Admission. 100%

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 protocols.

225%

ALTERNATIVE SERVICES N$ 50, 600 per family


In- and Out-of-Hospital Benefit including occupational therapy, private nursing, palliative care (end stage terminal diseases) and frail care.


MENTAL HEALTH 21 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 are part of the day-to-day benefit limits.

100% 21 days per beneficiary

INTERNAL PROSTHESIS Subject to RMA protocol

Internal prosthesis - example: knee / hip / pacemakers. Part of pre-authorisation and clinical risk management protocols.

100% Subject to RMA protocol

TRAUMA TREATMENT Unlimited

Oncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (In hospital). 225%

UnlimitedOncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (Out-of-hospital).

180%

Motor Vehicle Accidents (MVA). 225%

4

PROFESSIONAL SERVICESN$ 36, 800 per family


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 reports. Agreed Tariff

Pharmacist / General Practitioners and Psychologists telephone consultations. 100%

General Practitioner / primary and specialist procedures in rooms including equipment, materials and injections. 100%

Psychiatric and Psychology consultations and treatment. 100%

Radiology. 100%

Pathology. 100%

PARAMEDICAL SERVICES N$ 19, 600 per family


Including physiotherapy, social workers, speech therapy, audiology, acousticians, dieticians, occupational therapy, biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc.


Auxiliary services - Biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc. 100%

EXTERNAL PROSTHESIS AND MEDICAL APPLIANCESN$ 87, 500 per family


Prosthesis external - Artificial arms / legs / eyes every two years. Part of pre-authorisation and approval. 100% of cost

Part of the sub-limitSpecial 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


Eye tests. 100%Part of the sub-limit

Lenses / contact lenses. 100%

Frames, once every two years. 100% N$ 2, 300 per beneficiary

DENTISTRY BENEFITN$ 37, 700 per family


Conservative dentistry - Fillings, extractions and oral hygiene. 100%

Part of the sub-limitSpecial dentistry - Dental implants, crowns, bridges, dentures and orthodontic treatments. Part of pre-authorisation and approved treatment plan.

100%

MEDICATION BENEFITN$ 53, 600 per family


Acute Medication - Preferred and non-preferred. 80% NRPN$ 20, 700 per family


Pharmacy initiated therapy and OTC medication - including multivitamins, tonics and male contraceptives. Maximum of N$ 200 per script.

80% NRP N$ 1, 800 per beneficiary

Homeopathic medication. 80% NRPPart of Acute Medication sub-limit

Primary health scripts. 80% NRP

Chronic Medication - Preferred and non-preferred. Preferred 90% Non-preferred 80%

N$ 32, 900 per family


EXTENDED MEDICATION BENEFIT N$ 137, 400 per family

In- and Out-of-Hospital: Extended Medication Benefit cover for oncology (excluding chemo and radiation therapy and treatment), renal care, organ transplant, cardiovascular and diabetes related medication and 2 HBA1C rapid tests. 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-limitPreferred medication. 90% NRP

Non preferred medication. 80% 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

TARIFF % BENEFITSDAY-TO-DAY BENEFITS

IUD DEVICES (Intrauterine contraceptive device) N$ 6, 800 per beneficiary

Insertion of IUD (including device and procedure) 100% N$ 6, 800 per beneficiary

HEALTH IS VITAL Unlimited

Hospital and treatment. 100% Unlimited

HIV / AIDS visits. 100% N$ 3, 500 per family

HIV / AIDS pathology. 100% N$ 12, 700 per family

HIV / AIDS medication. 100% NRP N$ 41, 600 per family

HIV counselling. 100% N$ 4, 900 per family

PRESTIGE CARE

5

MATERNITY AND BABY BENEFIT (Including child beneficiary and third generation pregnacies - subject to Fund Rules) 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

PRESTIGE CARE

TARIFF % BENEFITSMATERNITY BENEFITS

WELLNESS MANAGEMENT N$ 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 measurement. 100%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 ages. 100% 1 per beneficiary

Prostate screening. Pathology prostate specific antigen test. 100% 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 Benefit.

100%

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 BEHAVIOUR Benefit Wallet Reward Points

Blood sugar test, cholesterol test, BMI and blood pressure measurement. 100

Dental examinations. 100

Mammogram (inclusive DEXA bone density scan) - Radiology. 150

Pap smear. Pathology including general practitioner / gynaecology visits. 100

HIV test, all ages. 100

Prostate screening. Pathology prostate specific antigen test. 150

Chronic medication compliance. 150

Lifestyle Rewards (for the participation in selective Regional Sport and Fitness events)

N$100 Benefit Rewards per beneficiary, per annum, to a maximum of N$ 1,200 per beneficiary, per annum.

Covid Vaccine RewardN$100 Benefit Rewards

per beneficiary, per annum, with proof of full Covid -19 vaccination.

IMMUNISATION (Vaccines only) Part of Wellness Management

Flu vaccines. 100% NRP 1 flu vaccination per beneficiary, per annum

Pneumococcal vaccine. 100% 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 years. 100% NRP 3 injections during the course of a year, once per lifetime

PREVENTATIVE REHABILITATION TREATMENT Part 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

INCLUSIVE BASE BENEFIT BUILDER N$ 480 per family

Additional medical benefits that allows for the payment of medication co-payments, levies, excess of tariff rejections and additional medical benefits. Optional additional Benefit Builders may be added.

100% of cost N$ 480 per family

TARIFF % BENEFITSINCLUSIVE BASE BENEFIT BUILDER

WELLNESS BENEFITS TARIFF % BENEFITS

6 PRESTIGE CARE

TARIFF % BENEFITSCOMPLEMENTARY BENEFITSPREMIUM PROTECTION Period

Covers monthly Medical Aid Fund contributions on the life of the Principal Member. 100% 3-months

TRAVEL AND ACCOMMODATION BENEFIT

Travel expenses (including accommodation) incurred to obtain medical treatment which is not available in your town of residence in or outside Namibia.

Where a Member obtains accommodation from a registered hospitality institution the claim would be paid, subject to the stipulated Benefit limits per Option.

Members opting to stay with family, may claim N$450 per day for accommodation, subject to the stipulated available Benefit limit per Option.

100% of cost N$ 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 in your threshold will be transferred to your Benefit Wallet. (Note: The balance is transferred after 4-months to allow for the run off of medical claims incurred in the previous year)

2. The threshold is a Family threshold and maximum calculation based on Principal Member plus 5 Dependants.

3. Members participating in Wellness Day initiatives, Fitness events and preventative testing as well as Covid-19 vaccinations, will earn additional Benefit Wallet rewards, this includes early registration on the maternity programme and additional rewards for normal births.

4. 80% unused Benefits in the Benefit Builder will be transferred annually to the Benefit Wallet. (Note: 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, 600Adult Dependant N$ 4, 200Child Dependant N$ 1, 900

BENEFIT WALLET

Registered beneficiaries only. Accumulated Benefit Wallet benefits can be used for purchasing of any 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.

Where medical aid benefit limits have been exceeded or tariff short payments have been rejected, such rejections may be paid directly to the Health Professional on receipt of a signed claim form from the member.

EARN WELLNESS POINTS for:• participation in Wellness Day initiatives• participation in Lifestyle and fitness events• preventative testing• Covid vaccinations • early registration on maternity programme• normal births

100% of cost

Subject to availability of Benefit Wallet Benefits,

medical treatment and services obtained from a registered

medical facility.

LONGSTANDING MEMBERSHIP REWARDS Group 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 contribution.

Provided 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 treatment. 100% Terms and conditions

Evacuation, repatriation, return of children. 100% Terms and conditions

Disclaimer: The Renaissance Health Medical Aid Fund (RMA) is registered with NAMFISA. It is governed by the Board of Trustees on behalf of the Members of the Fund and in terms of the Fund Rules as approved by NAMFISA. The RMA Fund Rules and benefits are subject to the approval of the Registrar of the Medical Aid Funds. This product guide is an extract from the Rules and Benefits and only serves as a reference guideline. Should there be any discrepancies, misprints and/or misinterpretations thereof, the Fund Rules as approved by NAMFISA will prevail.

7STATUS CARE

AGE



Principal Members


Principal Members


Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 25 3,375 2,135 1,605 2,925 1,835 1,380 2,735 1,720 1,275 2,605 1,655 1,205

26 - 30 3,910 2,955 1,605 3,390 2,540 1,380 3,175 2,385 1,275 3,005 2,265 1,205

31 - 35 4,445 3,255 1,605 3,855 2,820 1,380 3,595 2,640 1,275 3,425 2,515 1,205

36 - 40 4,850 3,585 1,605 4,225 3,115 1,380 3,935 2,890 1,275 3,750 2,790 1,205

41 - 45 5,405 4,170 1,605 4,670 3,605 1,380 4,360 3,385 1,275 4,165 3,215 1,205

46 - 50 5,965 4,660 1,605 5,190 4,060 1,380 4,825 3,780 1,275 4,625 3,595 1,205

51 - 55 6,455 5,010 1,605 5,620 4,345 1,380 5,250 4,075 1,275 5,000 3,860 1,205

56 - 60 6,970 5,385 1,605 6,055 4,660 1,380 5,645 4,325 1,275 5,410 4,150 1,205

61 - 65 7,615 6,010 1,605 6,620 5,190 1,380 6,175 4,845 1,275 5,880 4,600 1,205

66+ 8,300 6,660 1,605 7,180 5,795 1,380 6,705 5,385 1,275 6,405 5,145 1,205


OVERALL ANNUAL LIMIT Unlimited

STATUS CARE

OPTIONAL BENEFITS

CORE

BEN

EFITS

LIFESTYLE REWARDS

HOSPITAL BENEFITS



DAY-TO-DAY BENEFITS


WELLNESS BENEFITS



early detection.



BENEFIT WALLET







Customize your benefits for when and

if you need them.

See page 24.

EXTRA BENEFITS

8 STATUS CARE

TARIFF % BENEFITSHOSPITAL BENEFITSTOTAL ALL-INCLUSIVE OVERALL ANNUAL LIMIT Unlimited

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



Unlimited





Physiotherapy. 100%



SURGICAL PROCEDURES DONE IN ROOMS / UNATTACHED THEATRES Unlimited


225%

UnlimitedAdmission to unattached operating theatres and sub-acute facilities. 100%


225%










Admission. 100%


225%

EYE SURGERY Unlimited

Admission. 100%

UnlimitedIncluding cataract surgery, glaucoma surgery, eye muscle surgery, corneal surgery, eye removal, vitreo-retinal surgery, etc. (All-inclusive benefit - admission, surgery, treatment and services). Part of clinical protocols and after 1-year membership. 225%





Admission. 100%


225%











TRAUMA TREATMENT Unlimited


UnlimitedOncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (Out-of-hospital).

180%


9


STATUS CARE









Radiology. 100%

Pathology. 100%










90% of cost


80% of cost










100%

















80% NRP



HEALTH IS VITAL Part of the Overall Annual Limit

Hospital and treatment. 100% Part of the Overall Annual Limit





10 STATUS CARE

MATERNITY AND BABY BENEFIT (Including child beneficiary and third generation pregnacies - subject to Fund Rules) Part of the Overall Annual Limit


Gynaecology / obstetric - Out of hospital. 100% Part of Overall limit



Amniocentesis - AHB excluded. 100% Part of Overall limit













100%





























11STATUS CARE













Principal Member N$ 4, 900 Adult Dependant N$ 3, 800 Child Dependant N$ 1, 700

BENEFIT WALLET




100% of cost



medical facility.










Renaissance Health Medical Aid Fund Product Guide 202212

HAVE FULL CONTROL OF YOUR MEDICAL AID IN THE PALM OF YOUR HAND!

RMA wants you to have the best experience with your Medical Aid Fund, and that is why the RMA App offers you ultimate ease and convenience in managing your Medical Aid Benefits. With the app, you have access to your personal Member information, which you are able to maintain on the app. You can also view your available benefits and claim history on the app. This way, you will easily be able to track the way you have been using your Medical Aid option, and plan ahead for the rest of the benefit year!

Download the RMA App today, to have access to your Medical Aid at your finger tips. Wherever you may be, with RMA, Your Health Comes First.

12 Renaissance Health Medical Aid Fund Product Guide 2022

Update your personal information

View your available benefits

View your claim history

13Renaissance Health Medical Aid Fund Product Guide 2022 13Renaissance Health Medical Aid Fund Product Guide 2022

Buy over the counter medicine to treat less serious conditions and consider using generic medicine which is affordable and equally effective.

Ask your doctor what your out-of-pocket expense will be and what your Medical Aid will cover. If your out-of-pocket expense is too high, discuss with your doctor to adjust their fee or payment schedule.

Obtain pre-authorisation from the Fund (+264 83 299 9500 or [email protected]) before procedures or hospital admission.

If you suffer from a chronic condition such as diabetes, high blood pressure or HIV/AIDS, RMA offers a Disease Management Programme, which includes a chronic adherence monitoring for our Members. Register on the relevant Chronic Management Programme, the programme is there to help our Members to use their benefits to maximum advantage.

Go for your annual preventative screening tests that are covered by the Fund. Remember, prevention is better than cure. Members get rewarded via the Benefit Wallet for doing so.

Members of the Fund begin the year with a new slate and new Benefits. If you manage your medical expenses correctly, you can avoid out-of-pocket expenses and limit the possibility of running out of benefits.

ASK YOUR PHARMACIST

BEFORE HOSPITAL

ADMISSION, ASK YOUR DOCTOR

GET PRE-AUTHORISATION

FOR PROCEDURES

MANAGED CARE

BENEFITS

PREVENTATIVESCREENING

14


CALIBER CARE

AGE



Principal Members


Principal Members


Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 25 2,805 1,895 1,230 2,470 1,655 1,065 2,315 1,550 985 2,200 1,465 945

26 - 30 3,100 2,095 1,230 2,700 1,830 1,065 2,520 1,710 985 2,385 1,610 945

31 - 35 3,290 2,240 1,230 2,850 1,955 1,065 2,665 1,815 985 2,540 1,745 945

36 - 40 3,625 2,615 1,230 3,125 2,265 1,065 2,930 2,120 985 2,790 2,015 945

41 - 45 4,065 2,935 1,230 3,520 2,555 1,065 3,280 2,375 985 3,125 2,265 945

46 - 50 4,475 3,515 1,230 3,870 3,050 1,065 3,610 2,865 985 3,465 2,710 945

51 - 55 4,775 3,870 1,230 4,130 3,350 1,065 3,845 3,135 985 3,680 2,980 945

56 - 60 5,175 4,255 1,230 4,480 3,700 1,065 4,165 3,450 985 4,000 3,290 945

61 - 65 5,525 4,565 1,230 4,795 3,960 1,065 4,445 3,700 985 4,280 3,515 945

66+ 6,215 5,090 1,230 5,370 4,420 1,065 5,015 4,105 985 4,795 3,920 945

CALIBER CAREOVERALL ANNUAL LIMIT

Per family: N$ 3, 000, 000 Per beneficiary: N$ 2, 000, 000

OPTIONAL BENEFITS

CORE

BEN

EFITS

LIFESTYLE REWARDS

HOSPITAL BENEFITS



DAY-TO-DAY BENEFITS


WELLNESS BENEFITS



early detection.



BENEFIT WALLET








if you need them.

See page 24.

EXTRA BENEFITS

15CALIBER CARE

TARIFF % BENEFITSHOSPITAL BENEFITSTOTAL ALL-INCLUSIVE OVERALL ANNUAL LIMIT Part of the Overall Annual Limit

HOSPITAL BENEFIT GROUP (Subject to clinical risk management protocols) Part of the Overall Annual Limit

Private hospital (Including medicines, materials, hospital apparatus and seven days Take-Out Medication). 100% Part of the Overall Annual Limit



Part of the Overall Annual Limit





Physiotherapy. 100%



SURGICAL PROCEDURES DONE IN ROOMS / UNATTACHED THEATRES Part of the Overall Annual Limit


225%

Part of the Overall Annual LimitAdmission to unattached operating theatres and sub-acute facilities. 100%


225%










Admission. 100%


225%

EYE SURGERY Part of the Overall Annual Limit

Admission. 100%

Part of the Overall Annual LimitIncluding cataract surgery, glaucoma surgery, eye muscle surgery, corneal surgery, eye removal, vitreo-retinal surgery, etc. (All-inclusive benefit - admission, surgery, treatment and services). Part of clinical protocols and after 1-year membership. 225%





Admission. 100%


225%











TRAUMA TREATMENT Part of the Overall Annual Limit


Part of the Overall Annual LimitOncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (Out-of-hospital).

180%


16 CALIBER CARE









Radiology. 100%

Pathology. 100%










90% of cost


80% of cost










100%

















80% NRP










17CALIBER CARE



Gynaecology / obstetric - Out of hospital. 100% Part of the Overall Annual Limit



Amniocentesis - AHB excluded. 100% Part of the Overall Annual Limit













100%





























18 CALIBER CARE













Principal Member N$ 3, 800Adult Dependant N$ 2, 700Child Dependant N$ 1, 400

BENEFIT WALLET




100% of cost



medical facility.










19

MONTHLY CONTRIBUTIONS (GROUPS ONLY)

AGE



Principal Members


Principal Members


Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 25 1,905 1,330 855 1,660 1,145 740 1,575 1,075 700 1,470 1,005 650

26 - 30 2,075 1,425 855 1,800 1,240 740 1,700 1,155 700 1,590 1,090 650

31 - 35 2,245 1,550 855 1,945 1,340 740 1,815 1,245 700 1,710 1,200 650

36 - 40 2,475 1,835 855 2,165 1,580 740 2,015 1,500 700 1,900 1,400 650

41 - 45 2,765 2,030 855 2,395 1,770 740 2,240 1,645 700 2,130 1,550 650

46 - 50 3,080 2,440 855 2,665 2,115 740 2,490 1,960 700 2,355 1,880 650

51 - 55 3,505 2,875 855 3,060 2,510 740 2,840 2,345 700 2,690 2,205 650

56 - 60 3,865 3,280 855 3,360 2,850 740 3,120 2,640 700 2,945 2,485 650

61 - 65 4,200 3,505 855 3,660 3,025 740 3,415 2,845 700 3,210 2,685 650

66+ 4,490 3,695 855 3,900 3,195 740 3,625 2,995 700 3,450 2,820 650

INCOME

INDIVIDUAL RATESFor groups with 9 or less

Principal Members


Principal Members


Principal Members


Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 2, 000 2,380 1,525 830 2,085 1,330 720 1,940 1,230 665 1,835 1,195 635

2, 001 - 3, 000 2,485 1,890 830 2,145 1,650 720 2,015 1,540 665 1,905 1,470 635

3, 001 - 4, 000 2,735 2,240 830 2,390 1,945 720 2,235 1,810 665 2,120 1,730 635

4, 001 - 5, 000 3,080 2,555 830 2,685 2,230 720 2,490 2,075 665 2,380 1,975 635

5, 001 - 6, 000 3,390 2,870 830 2,945 2,495 720 2,755 2,355 665 2,640 2,235 635

6, 001+ 3,840 3,080 830 3,335 2,650 720 3,105 2,470 665 2,945 2,355 635

ESTEEM CARE


ESTEEM CAREOVERALL ANNUAL LIMIT

Per family: N$ 1, 680, 000 Per beneficiary: N$ 1, 103, 000

OPTIONAL BENEFITS

CORE

BEN

EFITS

LIFESTYLE REWARDS

HOSPITAL BENEFITS



DAY-TO-DAY BENEFITS


WELLNESS BENEFITS



early detection.



BENEFIT WALLET








if you need them.

See page 24.

EXTRA BENEFITS

20 ESTEEM CARE











Physiotherapy. 100%





180%



180%










Admission. 100%


180%


Admission. 100%






Admission. 100%


180%














180%


21ESTEEM CARE










Radiology. 100%

Pathology. 100%










90% of cost


80% of cost










100%



Acute Medication - Preferred and non-preferred. 80% NRP Part of Medication Benefit sub-limit



Homeopathic medication. 80% NRP

Part of Medication Benefit sub-limitPrimary health scripts. 80% NRP







80% NRP









22 ESTEEM CARE



















100%





























23ESTEEM CARE













Principal Member N$ 2, 400 Adult Dependant N$ 1, 700

Child Dependant N$ 900

BENEFIT WALLET




100% of cost



medical facility.











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.

Please call us at +264 83 299 9000 to apply.

Family Benefit Builder N$ 3, 000 N$ 2, 700 N$ 225





Family Benefit Builder N$ 15, 000 N$ 13, 500 N$ 1, 125





ELITE CARE √ PRESTIGE CARE √ STATUS CARE √ CALIBER CARE √ ESTEEM CARE √

EVOLVE CARE X PREMIERE CARE X PREMIERE CARE NETWORK X

BENEFIT BUILDERS ARE AVAILABLE ON THESE PRODUCT OPTIONS

BENEFIT BUILDERS



OPTIONAL BENEFIT BUILDERS ANNUAL CONTRIBUTION


INCLUSIVE BASE BENEFIT BUILDER TARIFF % BENEFITS

24


OPTIONAL BENEFIT BUILDER COVER 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

Travel expenses (including accommodation) incurred to obtain medical treatment which is not available in your town of residence in or outside Namibia. Where a member obtains accommodation from a registered hospitality institution the claim would be paid, subject to the stipulated Benefit limits per Option. Members opting to stay with family, may claim N$450 per day for accommodation, subject to the stipulated available Benefit limit per Option.


MEDICATION

Acute medication (Non-preferred and preferred medication) including homeopathic medication and primary health scripts.

100% NRP

Part of the family limitPharmacy 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 limitFrames.

Eye tests.

DENTISTRY BENEFIT

Conservative dentistry and specialised dentistry including - Fillings, extractions and oral hygiene, dental implants, crowns, bridges, dentures and orthodontic treatment.


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)



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.


EYE SURGERY



RECONSTRUCTIVE SURGERY

Reconstructive Surgery - After two years membership, including breast reductions. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols.


ALTERNATIVE SERVICES



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.


HEALTH IS VITAL

HIV / AIDS visits.

100% Part of the family limitHIV / AIDS pathology.

HIV / AIDS medication.

HIV counselling.

26

INCOME


Principal Members


Principal Members


Principal Members


Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 2, 000 1,485 890 550 1,315 755 475 1,215 715 465 1,155 700 420

2, 001 - 4, 000 1,685 1,030 550 1,475 885 475 1,360 830 465 1,310 810 420

4, 001 - 6, 000 2,080 1,460 565 1,790 1,265 480 1,660 1,195 470 1,610 1,145 435

6, 001+ 2,180 1,495 580 1,875 1,315 495 1,765 1,230 485 1,675 1,170 445

AGE



Principal Members


Principal Members


Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 25 1,320 915 595 1,145 790 510 1,085 740 485 1,010 700 455

26 - 30 1,440 985 595 1,240 850 510 1,165 800 485 1,095 750 455

31 - 35 1,555 1,070 595 1,335 920 510 1,250 865 485 1,180 825 455

36 - 40 1,710 1,265 595 1,490 1,090 510 1,390 1,040 485 1,315 970 455

41 - 45 1,900 1,400 595 1,655 1,220 510 1,550 1,140 485 1,470 1,070 455

46 - 50 2,120 1,685 595 1,835 1,465 510 1,720 1,355 485 1,625 1,305 455

51 - 55 2,425 1,980 595 2,110 1,730 510 1,960 1,620 485 1,860 1,520 455

56 - 60 2,675 2,260 595 2,320 1,965 510 2,150 1,820 485 2,030 1,715 455

61 - 65 2,900 2,425 595 2,520 2,095 510 2,355 1,965 485 2,215 1,855 455

66+ 3,100 2,555 595 2,685 2,200 510 2,505 2,065 485 2,380 1,950 455

EVOLVE CARE



OVERALL ANNUAL LIMIT

Per family: N$ 1, 165, 500 Per beneficiary: N$ 787, 500

EVOLVE CARE

OPTIONAL BENEFITS

CORE

BEN

EFITS

LIFESTYLE REWARDS

HOSPITAL BENEFITS



DAY-TO-DAY BENEFITS


WELLNESS BENEFITS



early detection.



BENEFIT WALLET




Not available on Evolve Care.


Not available on Evolve Care.

EXTRA BENEFITS

27EVOLVE CARE











Physiotherapy. 100%





180%



180%










Admission. 100%


180%


Admission. 100%






Admission. 100%


180%














180%


28 EVOLVE CARE









Radiology. 100%

Pathology. 100%










90% of cost


80% of cost





Frames, once every two years. 100% N$ 750 per beneficiary





100%



Acute Medication - Preferred and non-preferred. 80% NRP Part of Medication Benefit sub-limit



Homeopathic medication. 80% NRP

Part of Medication Benefit sub-limitPrimary health scripts. 80% NRP







80% NRP










29EVOLVE CARE



















100%




















PREVENTATIVE REHABILITATION TREATMENT No benefit



No benefit


30 EVOLVE CARE












Principal Member N$ 1, 700Adult Dependant N$ 1, 200

Child Dependant N$ 600

BENEFIT WALLET




100% of cost



medical facility.










31

INCOME


Principal Members


Principal Members


Principal Members


Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 1, 500 685 475 210 590 420 180 550 380 175 510 360 170

1, 501 - 3, 000 760 540 230 635 475 215 600 440 190 575 435 175

3, 001 - 6, 000 895 630 295 760 535 255 720 515 215 700 490 215

6, 001 + 1,235 850 385 1,055 755 320 990 720 300 955 670 295

PREMIERE CARE

AGE



Principal Members


Principal Members


Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 25 700 485 290 605 420 250 575 395 235 540 365 220

26 - 30 745 510 290 645 440 250 605 415 235 570 390 220

31 - 35 775 535 290 665 465 250 630 430 235 590 410 220

36 - 40 830 620 290 725 525 250 675 505 235 640 470 220

41 - 45 930 685 290 815 595 250 755 560 235 720 520 220

46 - 50 1,060 840 290 915 730 250 855 675 235 815 650 220

51 - 55 1,210 990 290 1,055 865 250 980 810 235 930 760 220

56 - 60 1,335 1,130 290 1,160 980 250 1,075 910 235 1,015 855 220

61 - 65 1,455 1,210 290 1,260 1,045 250 1,175 980 235 1,110 925 220

66+ 1,550 1,280 290 1,340 1,095 250 1,250 1,035 235 1,195 975 220




Unlimited at State HospitalsPer family: N$ 368, 000 at Private Hospitals

PREMIERE CARE

OPTIONAL BENEFITS

CORE

BEN

EFITS

LIFESTYLE REWARDS

HOSPITAL BENEFITS



DAY-TO-DAY BENEFITS


WELLNESS BENEFITS



early detection.



BENEFIT WALLET




Not available on Premiere Care.


Not available on Premiere Care.

EXTRA BENEFITS

Subject to benefit rules.

32 PREMIERE CARE

TARIFF % BENEFITSHOSPITAL BENEFITSTOTAL ALL-INCLUSIVE OVERALL ANNUAL LIMIT Unlimited 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% N$ 368, 000 per family

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% Unlimited

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


Part of the Overall Annual LimitBlood transfusion. 100%


Physiotherapy. 100%

Post-Operative Extended Benefit (Following major surgery). Part of pre-authorisation and clinical protocols. 100% No benefit




100%



100%




MAXILLOFACIAL AND DENTAL SURGERY (In- and Out-of-Hospital) N$ 16, 300 per family



DENTAL AND ORAL SURGERY No benefit

Admission.State facilities only

No benefit in private hospitalsElective 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.

EYE SURGERY N$ 54, 000 per family

Admission.

100% Part of the sub-limitIncluding cataract surgery, glaucoma surgery, eye muscle surgery, corneal surgery, eye removal, vitreo-retinal surgery, etc. (All-inclusive benefit - admission, surgery, treatment and services). Part of clinical protocols and after 1-year membership.


No benefit

RECONSTRUCTIVE SURGERY No benefit


No benefit in private hospitalsReconstructive Surgery - After two-years membership, including breast reductions. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols.

ALTERNATIVE SERVICES No benefit


State facilities only

No benefit in private hospitals

MENTAL HEALTH


100%State facilities only


INTERNAL PROSTHESIS




TRAUMA TREATMENT

Oncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (In hospital).


No benefit in private hospitalsOncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (Out-of-hospital).

Motor Vehicle Accidents (MVA).

33PREMIERE CARE




General Practitioner, specialist consultations and primary healthcare consultations. 100% Part of Professional Service limit

After hours General Practitioner, specialist or primary healthcare consultations. Agreed Tariff Part of the sub-limit

Pharmacist / General Practitioner telephone consultations. 100%

Part of Professional Service limitGeneral Practitioner / primary and specialist procedures in rooms including equipment, materials and injections.

100%

Psychiatric and Psychology consultations and treatment. State facilities only

Radiology. 100% Part of Professional Service limit

Pathology. 100%

PARAMEDICAL SERVICES No benefit

Including physiotherapy, social workers, speech therapy, audiology, acousticians, dieticians, occupational therapy, biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc. State facilities only

Auxiliary services - Biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc.

EXTERNAL PROSTHESIS AND MEDICAL APPLIANCES No benefit

Prosthesis external - Artificial arms / legs / eyes every two years. Part of pre-authorisation and approval.

State facilities onlySpecial external medical appliances - Wheelchairs every three years; hearing aids apparatus every two years. Part of pre-authorisation and approval.


OPTICAL BENEFIT N$ 950 per family

N$ 630 per beneficiary

Eye tests. 100%

Part of the sub-limitLenses / contact lenses. 100%

Frames, once every two years. 100%



Conservative dentistry - Fillings, extractions and oral hygiene. 100% Part of the sub-limit

Special dentistry - Dental implants, crowns, bridges, dentures and orthodontic treatments. Part of pre-authorisation and approved treatment plan.

100% Plastic dentures every 2 years



Acute Medication - Preferred and non-preferred. 100% NRP Part of the sub-limit

Pharmacy initiated therapy and OTC medication - including multivitamins, tonics and male contraceptives. Maximum of N$ 200 per script. No benefit

Homeopathic medication.

Primary health scripts. 100% NRPPart of the sub-limit

Chronic Medication - Preferred and non-preferred. 100% NRP

COVID MEDICATION N$ 5, 000 per family

Approved basket of medication for the treatment of Covid-19. 100% NRP N$ 5,000 per family

EXTENDED MEDICATION BENEFIT No benefit


State facilities onlyPreferred medication.

Non preferred medication.


IUD DEVICES (Intrauterine contraceptive device) No benefit

Insertion of IUD (including device and procedure) No benefit







34 PREMIERE CARE


Gynaecology / obstetric - In hospital. 180% Part of the sub-limit in private hospitals

Unlimited in State facilitiesGynaecology / obstetric - Out of hospital. 100%



Amniocentesis - AHB excluded. 100% Part of the sub-limit in private hospitals

Unlimited in State facilitiesNeonatal ICU / ward fees. 100%

Paediatrician visits - Postnatal. 100%











100%























No benefit


35PREMIERE CARE



TRAVEL AND ACCOMMODATION BENEFIT No benefit

Transport cost when referred for specialist services not available in the area of residence. No benefit





Principal Member N$ 700 Adult Dependant N$ 450Child Dependant N$ 200

BENEFIT WALLET




100% of cost



medical facility.










36 PREMIERE CARE - NETWORK

INCOME


Principal Members


Principal Members


Principal Members


Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 1, 500 685 475 210 590 420 180 550 380 175 510 360 170

1, 501 - 3, 000 760 540 230 635 475 215 600 440 190 575 435 175

3, 001 - 6, 000 895 630 295 760 535 255 720 515 215 700 490 215

6, 001 + 1,235 850 385 1,055 755 320 990 720 300 955 670 295

AGE



Principal Members


Principal Members


Principal Members

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

Principal Member

Adult Dependant

Child Dependant

0 - 25 700 485 290 605 420 250 575 395 235 540 365 220

26 - 30 745 510 290 645 440 250 605 415 235 570 390 220

31 - 35 775 535 290 665 465 250 630 430 235 590 410 220

36 - 40 830 620 290 725 525 250 675 505 235 640 470 220

41 - 45 930 685 290 815 595 250 755 560 235 720 520 220

46 - 50 1,060 840 290 915 730 250 855 675 235 815 650 220

51 - 55 1,210 990 290 1,055 865 250 980 810 235 930 760 220

56 - 60 1,335 1,130 290 1,160 980 250 1,075 910 235 1,015 855 220

61 - 65 1,455 1,210 290 1,260 1,045 250 1,175 980 235 1,110 925 220

66+ 1,550 1,280 290 1,340 1,095 250 1,250 1,035 235 1,195 975 220




Unlimited at State HospitalsPer family: N$ 368, 000 at Private Hospitals

PREMIERE CARE NETWORK

OPTIONAL BENEFITS

CORE

BEN

EFITS

LIFESTYLE REWARDS

HOSPITAL BENEFITS



DAY-TO-DAY BENEFITS


WELLNESS BENEFITS



early detection.



BENEFIT WALLET




Not available on Premier Care

Network.


Not available on Premier Care

Network.

EXTRA BENEFITS

Subject to benefit rules.

37PREMIERE CARE - NETWORK

TARIFF % BENEFITSHOSPITAL BENEFITSTOTAL ALL-INCLUSIVE OVERALL ANNUAL LIMIT Unlimited 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% N$ 368, 000 per family

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% Unlimited

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


Part of the Overall Annual LimitBlood transfusion. 100%


Physiotherapy. 100%

Post-Operative Extended Benefit (Following major surgery). Part of pre-authorisation and clinical protocols. 100% No benefit




100%



100%




MAXILLOFACIAL AND DENTAL SURGERY (In- and Out-of-Hospital) N$ 16, 300 per family



DENTAL AND ORAL SURGERY No benefit


No benefit in private hospitalsElective 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.

EYE SURGERY N$ 54, 000 per family

Admission.

100% Part of the sub-limitIncluding cataract surgery, glaucoma surgery, eye muscle surgery, corneal surgery, eye removal, vitreo-retinal surgery, etc. (All-inclusive benefit - admission, surgery, treatment and services). Part of clinical protocols and after 1-year membership.


No benefit

RECONSTRUCTIVE SURGERY No benefit


No benefit in private hospitalsReconstructive Surgery - After two-years membership, including breast reductions. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols.

ALTERNATIVE SERVICES No benefit


State facilities only


MENTAL HEALTH




INTERNAL PROSTHESIS




TRAUMA TREATMENT

Oncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (In hospital).


No benefit in private hospitalsOncology (Including chemo and radiation treatment), organ transplant, acute renal and peritoneal dialysis (Out-of-hospital).

Motor Vehicle Accidents (MVA).

38 PREMIERE CARE - NETWORK

TARIFF % BENEFITSDAY-TO-DAY BENEFITSPROFESSIONAL SERVICES Unlimited


Unlimited GP consultations (N$10 per visit.)

Specialist consultations on referral of Network provider only (N$10 per visit)

After hours General Practitioner, specialist or primary healthcare consultations. Agreed Tariff 3 consultations per family

Pharmacist / General Practitioner telephone consultations. 100% 2 consultations per beneficiary

General Practitioner / primary and specialist procedures in rooms including equipment, materials and injections.

100% Unlimited (N$10 per visit.)

Psychiatric and Psychology consultations and treatment. State facilities only

Radiology. 100% Basic black and white only

Pathology. 100% Basic pathology only

PARAMEDICAL SERVICES No benefit

Including physiotherapy, social workers, speech therapy, audiology, acousticians, dieticians, occupational therapy, biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc. State facilities only

Auxiliary services - Biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc.

EXTERNAL PROSTHESIS AND MEDICAL APPLIANCES No benefit

Prosthesis external - Artificial arms / legs / eyes every two years. Part of pre-authorisation and approval.

State facilities onlySpecial external medical appliances - Wheelchairs every three years; hearing aids apparatus every two years. Part of pre-authorisation and approval.


OPTICAL BENEFIT N$ 950 per family

N$ 630 per beneficiary

Eye tests. 100%

Part of the sub-limitLenses / contact lenses. 100%

Frames, once every two years. 100%



Conservative dentistry - Fillings, extractions and oral hygiene. 100% Part of the sub-limit

Special dentistry - Dental implants, crowns, bridges, dentures and orthodontic treatments. Part of pre-authorisation and approved treatment plan.

100% Plastic dentures every 2 years

MEDICATION BENEFIT Unlimited

Acute Medication - Preferred and non-preferred. 100% NRP Script limit N$ 280


100% NRP N$ 800 per family

Script limit N$ 200Homeopathic medication. 100% NRP

Primary health scripts. 100% NRP Script limit N$ 280

Chronic Medication - Preferred and non-preferred. 100% NRPN$ 4, 000 per family

Script limit N$ 280

COVID MEDICATION N$ 5, 000 per family

Approved basket of medication for the treatment of Covid-19. 100% NRP N$ 5,000 per family

EXTENDED MEDICATION BENEFIT No benefit


State facilities onlyPreferred medication.

Non preferred medication.


IUD DEVICES (Intrauterine contraceptive device) No benefit

Insertion of IUD (including device and procedure) No benefit







39PREMIERE CARE - NETWORK


Gynaecology / obstetric - In hospital. 180% Part of the sub-limit in private hospitals

Unlimited in State facilitiesGynaecology / obstetric - Out of hospital. 100%



Amniocentesis - AHB excluded. 100% Part of the sub-limit in private hospitals

Unlimited in State facilitiesNeonatal ICU / ward fees. 100%

Paediatrician visits - Postnatal. 100%











100%























No benefit


40



TRAVEL AND ACCOMMODATION BENEFIT No benefit

Transport cost when referred for specialist services not available in the area of residence. No benefit





Principal Member N$ 700 Adult Dependant N$ 450Child Dependant N$ 200

BENEFIT WALLET




100% of cost



medical facility.










PREMIERE CARE - NETWORK


USE IT AS A TOP-UP ON

ANY BENEFITOF YOURCHOICE

INCLUSIVE BASE BENEFIT

BUILDER

41

EARN REWARDS

SPEND REWARDS

BENEFIT BUILDER

ROLLOVER

LOW CLAIM

REWARDS

WELLNESS REWARDS

LIFESTYLE REWARDS

COVER CO-PAYMENTS

ON MEDICINE OR DOCTOR

VISITS

USE IT ON HEALTH-STYLEESSENTIALS LIKEPRESCRIPTION SUNGLASSES

(excluding Evolve Care, Premiere Care & Premier Care Network)

RECEIVE

BENEFIT WALLET REWARDING YOUR HEALTH


FREQUENTLY ASKED QUESTIONS

When can I join the Fund? Fund Membership is effective from the first day of the

month. Applications should preferably be received 2 weeks before the joining date to go through the approval process. If the application is only received during the month of joining (e.g. the 10th of January for the 1st of January) an arrangement should be made on how the outstanding payment will be settled since contributions are payable one month in advance.

What do pro-rated benefits mean? As the Fund’s benefit year is from 1 January to

31 December, any Member who joins during the benefit year may receive pro-rated benefits at joining and on termination. That means that your annual limits on benefits may be calculated according to the number of months left in the benefit year.

When can I change my benefit option? Members are allowed to change benefit options once

annually, effective from the 1st of January each year. The closing date for all option changes is the 31st of January.

What are pre-existing conditions? A pre-existing condition is any medical-related

condition and/or symptom for which treatment was received before joining with long term consequences. A 12-month exclusion period may be placed on such conditions, meaning that all costs incurred on any related symptoms and/or treatment will not be covered during this period.

What are co-payments and how can you prevent it?

Co-payments are the difference between the amount claimed by your Health Care Provider (doctor, specialist, dentist, hospitals etc.) and what your Medical Aid Fund pays. The Medical Aid Fund pays 100% of the NAMAF (Namibian Association of Medical Aid Funds) rates. Members can avoid co-payments by making use of service providers who charge the NAMAF tariff.

CLAIMS INFORMATION

When should you submit claims? All claims should be submitted within 4-months from

the date on which the service was rendered, otherwise, you may lose your right to payment in respect of these claims.

Do I receive immediate cover if I join the Fund and can I claim immediately?

There may be a waiting period of 3-months before you are covered for full benefits. A waiting period may apply if you were not a member of a registered medical aid fund for at least two years previously, and the break-in membership between leaving your previous fund and joining Renaissance Health (RMA) is more than 3-months.

Am I covered while travelling abroad? All Members have International Travel Cover included

in their Medical Aid benefits, which is underwritten by Hollard Insurance. Members may contact client service for assistance with regard to travel cover.

MEMBERSHIP INFORMATION

May I still continue with my Medical Aid as an Individual Member or retiree?

If a member has been on the Fund through their employer and leaves the employer, they may continue with their cover as an Individual Member or retiree.

Can the dependants remain on the Fund if the principal member passes on?

Beneficiaries (spouse and children) of deceased members, who are registered with the Fund at the time of the Principal Member’s death, are entitled to remain as Members on the Fund. The family should inform the Fund in writing within 30-days of the Principal Member’s death.

Up to what age may my child be on my Medical Aid as a child dependant?

Your child may be a dependant up to the age of 25. New members joining with a child over the age of 21 will need to submit proof of financial dependence on the parent.

When are my contribution payments due? Monthly payments are payable in advance by no later

than the 7th of every month. All debit order payments are deducted on the 1st of every month, except if it falls on a weekend or public holiday. In this case, the debit order may be deducted on the following working day.

What will happen if I fail to pay my monthly contributions?

The Fund may suspend the payment of claims if you are more than 30-days behind. The Fund may terminate your Membership if your contributions are in arrears for more than 90-days.

May I be a member of more than one (1) Medical Aid Fund?

In terms of the Medical Aid Funds Act, no person shall be admitted as a member of more than one registered Fund, being either as the principal member or as a dependant.

What should I do when my membership card is lost or stolen?

Should a Membership card be stolen or lost the member must inform the Fund immediately. Failing to do so, the Member could be held personally liable for any expenses incurred due to fraudulent use.

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Renaissance Health Medical Aid Fund Product Guide 20224444 Renaissance Health Medical Aid Fund Product Guide 2022

CLIENT SERVICE+264 83 299 [email protected]

NEW [email protected]

[email protected]

[email protected]

HOSPITAL PRE-AUTHORISATION+264 83 299 [email protected]

24-HOUR EMERGENCY & SUPPORT+264 61 2999 363

REGISTRATIONCHRONIC PROGRAMMEDISEASE MANAGEMENT PROGRAMMEHIV MANAGEMENT PROGRAMMEMATERNITY PROGRAMME

+264 83 299 9000

SUPPORT

WINDHOEKc/o Feld & Thorer StP.O. Box 22927, WindhoekTel: +264 83 299 9000Fax: +264 61 222 161

LÜDERITZBismarck St, No. 230P.O. Box 1178LüderitzTel: +264 63 202 143Fax: +264 63 204 169

ORANJEMUNDc/o 11th Ave & 12th StP.O. Box 833, OranjemundTel: +264 83 323 2111 / 3 / 0Fax: +264 63 232 191

ONGWEDIVAOngwediva Medipark ComplexAuguste Taanyanda St, Erf 7034Tel: +264 83 323 2080 / 81 / 82Fax: +264 88 656 1769

+264 88 655 5514

ROSH PINAHKokerboom StUnit 1 SME ParkP.O. Box 71, Rosh PinahTel: +264 83 323 2130 / 1Fax: +264 63 274 959

SWAKOPMUNDThe Dome. Unit 23 - Unit F 3Erf 5371, Welwitchia StreetP.O. Box 2869, SwakopmundTel: +264 83 323 2050Fax: +264 88 655 2774

TSUMEB1150 Sam Nujoma DriveP.O. Box 791, TsumebTel: +264 83 323 2070 / 2 / 3Fax: +264 88 655 5509

WALVIS BAYMedical ParkHidipo Hamutenya StP.O. Box 731, Walvis BayTel: +264 83 323 2000Fax: +264 64 206 094

BRANCHES

MEMBER PRODUCT MANAGEMENT

You can use it to:

• Check your available benefits• Check claims you made• Check payments made to you• Search for medical practitioners• View pre-authorizations• Find out if you have exclusions• Confirm dependants• Update your member details• Register for the maternity programme

MEMBER MOBILE APPUse the Member Mobile App to manage your Renaissance Health Product in conjunction with the Member portal. The RMA Mobile App is available for Renaissance Health Members at no cost.

MEMBER PORTALUse the Member portal to manage your Renaissance Health Product in conjunction with the Member Mobile App

• Visit www.rmanam.com• Go to the drop down menu

‘Home’• Select ‘Portal Login’• A new login window will open.

If you have not yet registered, you will find links that help you register, as well as an explainer on how to use the portal.

How to get the app:

• Search for RMA on the App store or Google play and download the app.

• Follow the easy instructions to register.

product guide 2022

Documents