Esteem Care Medical Aid Package
OAL Per family N$ 1,68 million / Per beneficiary N$ 1,1 million | From N$2380/Month
Esteem Care is the perfect medical aid for those who are quickly climbing the corporate ladder. This option is all inclusive, and it is the first option to give you access to the benefit builder, allowing you more control and personalization.
Hospital Benefit
Part of Overall Annual Limit
Doctor Service
N$ 18, 300 per year
Optical Benefit
N$ 4, 800 per year
Dental Benefit
N$ 12, 400 per year
 Hospital Benefits |
TARIFF % | BENEFITS |
| TOTAL ALL-INCLUSIVE OVERALL ANNUAL LIMIT | Per family: N$ 1, 680, 000 Per beneficiary: N$ 1, 103, 000 | |
| 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 |
| Accommodation in private wards. | 100% | N$ 18, 900 per family N$ 10, 000 per beneficiary |
| State hospitals (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% | |
| Consultations including treatment and services. | 150% | |
| 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 | Part of the Overall Annual Limit | |
| Doctors’ rooms / Unattached theatres - Selective surgical and endoscopic procedures, circumcisions. Inclusive benefit - Admissions, surgery, treatment and services. Part of pre-authorisation and clinical protocols. | 125% | Part of the Overall Annual Limit |
| Admission to unattached operating theatres and sub-acute facilities. | 100% | Part of the Overall Annual Limit |
| MRI / CT / PET SCAN / BONE DENSITY (In- and Out-of-Hospital) | N$ 33, 000 per family N$ 16, 500 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$ 37, 500 per family N$ 25, 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." | 125% | Part of the sub-limit |
| DENTAL AND ORAL SURGERY | N$ 5, 900 per family N$ 4, 300 per beneficiary | |
| Admission. | 100% | 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." | 125% | |
| EYE SURGERY | Part of the Overall Annual Limit | |
| Admission. | 100% | Part of the Overall Annual Limit |
| Including glaucoma surgery, eye muscle surgery, corneal surgery, vitreo-retinal surgery, eye removal, etc. (All-inclusive benefit - admission, surgery, treatment and services). Part of clinical protocols. | 125% | Part of the Overall Annual Limit |
| Cataract surgery only after one year membership. (All-inclusive benefit - admission, surgery, treatment and services). Part of clinical protocols. | 125% | N$ 35, 000 per family |
| Excimer laser and radial keratotomy only after two years membership. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols. | 125% | N$ 15, 000 per family N$ 10, 000 per beneficiary |
| RECONSTRUCTIVE SURGERY | N$ 12, 800 per family N$ 8, 500 per beneficiary | |
| 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." | 125% | |
| ALTERNATIVE SERVICES | N$ 15, 000 per family | |
| In- and Out-of-Hospital Benefit including occupational therapy, private nursing, palliative care (end stage terminal diseases) and frail care. | 100% | Part of the sub-limit |
| MENTAL HEALTH | N$ 35, 000 per family | |
| "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% | Part of the sub-limit |
| INTERNAL PROSTHESIS | N$ 58, 000 per family | |
| Internal prosthesis - example: knee / hip / pacemakers. Part of pre-authorisation and clinical risk management protocols. | 100% | Part of the sub-limit |
| TRAUMA TREATMENT | Part of the Overall Annual Limit | |
| Acute renal and peritoneal dialysis. (In- and Out-of-Hospital). | 125% | Part of Overall limit |
| Organ transplant. (In- and Out-of-Hospital). | 125% | N$ 200, 000 per family |
| Oncology treatment and services. (In- and Out-of-Hospital). | 125% | N$ 400, 000 per family |
| Specialised chemotherapeutic and high cost medication treatment. Part of clinical protocols and applicable Medical Aid Fund Rules. | No Benefit | |
| Motor Vehicle Accidents (MVA). | 125% | Part of Overall limit |
| 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 | ||
| 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 |
 Day To Day Benefits |
TARIFF % | BENEFITS |
| PROFESSIONAL SERVICES | N$ 18, 300 per family N$ 9, 200 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 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$ 5, 600 per family N$ 3, 700 per beneficiary | |
| Including physiotherapy, social workers, speech therapy, audiology, acousticians, dieticians, occupational therapy, biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc. | 100% | Part of the sub-limit |
| Auxiliary services - Biokinetics, homeo / chiro / osteopathy, podiatry, acupuncture, etc. | 100% | |
| EXTERNAL PROSTHESIS AND MEDICAL APPLIANCES | N$ 22, 500 per family N$ 12, 500 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$ 4, 800 per family N$ 2, 500 per beneficiary | |
| Eye tests. | 100% | Part of the sub-limit |
| Lenses / contact lenses. | 100% | |
| Frames, once every two years | 100% | N$ 1, 050 per beneficiary |
| DENTISTRY BENEFIT | N$ 12, 400 per family N$ 6, 600 per beneficiary | |
| 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% | |
| MEDICATION BENEFIT | N$ 12, 200 per family N$ 6, 200 per beneficiary | |
| Acute Medication - Preferred and non-preferred | 80% NRP | Part of Medication Benefit sub-limit |
| Pharmacy initiated therapy and OTC medication - including multivitamins, tonics and male contraceptives. Maximum of N$ 200 per script. | 80% NRP | N$ 1, 400 per beneficiary |
| Chronic Medication - Preferred and non-preferred. | Preferred 90% Non-preferred 80% | Part of Medication Benefit sub-limit |
| EXTENDED MEDICATION BENEFIT | N$ 68, 700 per family | |
| In- and Out-of-Hospital: Extended Medication Benefit cover for renal care and organ transplant. Part of registration and treatment plan protocols. Including specialised medicines such as biologicals in terms of defined conditions and treatment plan protocols. Excluding off-label medication. | 80% NRP | Part of the sub-limit |
 Maternity Benefits |
TARIFF % | BENEFITS |
| MATERNITY AND BABY BENEFIT (Including child beneficiary and third generation pregnacies - subject to Fund Rules) | Part of the Overall Annual Limit | |
| Gynaecology / obstetric - In hospital. | 125% | Normal birth / Caesarean Section |
| Gynaecology / obstetric - Out of hospital | 100% | Part of the Overall Annual Limit |
| 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% | Part of the Overall Annual Limit |
| Paediatrician visits - Postnatal. | 100% | 2 visits per family, per annum |
 WELLNESS BENEFITS |
TARIFF % | 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% | 1 per beneficiary, per annum |
| 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. | |
| Generic medication compliance of a minimum of 80%. | 150 | |
| 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. | 100% | 6-weeks treatment or 12 sessions |
| (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). | ||
 |
 INCLUSIVE BASE BENEFIT BUILDER |
TARIFF % | BENEFITS |
| INCLUSIVE BASE BENEFIT BUILDER | N$ 500 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$ 500 per family | |
 Complementary Benefits |
TARIFF % | BENEFITS |
| PREMIUM 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. | 100% of cost | N$ 3, 800 per family |
| 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$450 per day for accommodation, subject to the stipulated available Benefit limit per Option. | ||
| BENEFIT REWARDS | Low claiming threshold levels | |
| 1. Each Dependant is allocated with a threshold value per annum. Should you claim less than your threshold value as at 31 December of each year, the remaining balance in your threshold will be transferred to your Benefit Wallet. | Principal Member N$ 2, 400 Adult Dependant N$ 1, 700 Child Dependant N$ 900 | |
| (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) | ||
| BENEFIT WALLET | Low claiming threshold levels | |
| 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. | 100% of cost | Subject to availability of Benefit Wallet Benefits, medical treatment and services obtained from a registered medical facility |
| 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 | ||
| 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. | ||
