Evolve Care Medical Aid Package

OAL Per family N$ 1.17 Million / Per beneficiary N$ 787,500 | From N$1650/Month

As your life evolves, your medical aid should too. Evolve Care is a medical aid option which evolves around your stage in life; your monthly contributions can be determined by either your income or age, giving you the financial flexibility you need.

Hospital Benefit

Part of Overall Annual Limit

Doctor Service

N$ 15, 700 per year

Optical Benefit

N$ 2, 200 per year

Dental Benefit

N$ 5, 300 per year

Hospital Benefits TARIFF % BENEFITS
TOTAL 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
Accommodation in private wards. 100% N$ 10, 000 per family
N$ 5, 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. 125%
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%
MRI / CT / PET SCAN / BONE DENSITY (In- and Out-of-Hospital) N$ 16, 500 per family
N$ 8, 300 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$ 28, 100 per family
N$ 18, 700 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$ 4, 700 per family
N$ 3, 100 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. No Benefit
Excimer laser and radial keratotomy only after two years membership. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols. No Benefit
RECONSTRUCTIVE SURGERY N$ 6, 000 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." 125%
ALTERNATIVE SERVICES N$ 9, 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$ 33, 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$ 48, 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$ 150, 000 per family
Oncology (Including basic chemo and radiation treatment) (In- and Out-of-Hospital). 125% N$ 200, 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 Part of the Overall Annual Limit
Hospital and treatment. 100% Part of the Overall Annual Limit
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$ 8, 500 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$ 4, 000 per family
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$ 12, 200 per family
N$ 8, 100 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$ 2, 200 per family
N$ 1, 500 per beneficiary
Eye tests. 100% Part of the sub-limit
Lenses / contact lenses. 100%
Frames, once every two years 100% N$ 750 per beneficiary
DENTISTRY BENEFIT N$ 5, 300 per family
N$ 3, 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$ 10, 700 per family
N$ 5, 400 per beneficiary
Acute Medication - Preferred and non-preferred 80% NRP Part of Medication Benefit sub-limit
Pharmacy-initiated therapy and OTC medication as approved by the Fund. Maximum of N$ 180 per script. 80% NRP N$ 900 per family
Chronic Medication - Preferred and non-preferred. Subject to a defined list of conditions available on the RMA website per Benefit option. Preferred 90% Non-preferred 80% Part of Medication Benefit sub-limit
EXTENDED MEDICATION BENEFIT N$ 45, 800 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. 100% 100% 100% 100% NRP 100% DAY-TO-DAY BENEFITS PROFESSIONAL SERVICES TARIFF % BENEFITS N$ 8, 500 per family 100% Agreed Tariff 100% 100% 100% 100% 100% PARAMEDICAL SERVICES 100% 100% EXTERNAL PROSTHESIS AND MEDICAL APPLIANCES N$ 12, 200 per family N$ 8, 100 per beneficiary 100% of cost 90% of cost 80% of cost OPTICAL BENEFIT N$ 2, 200 per family N$ 1, 500 per beneficiary 100% 100% 100% DENTISTRY BENEFIT N$ 5, 300 per family N$ 3, 600 per beneficiary 100% 100% MEDICATION BENEFIT N$ 10, 700 per family N$ 5, 400 per beneficiary 80% NRP EXTENDED MEDICATION BENEFIT 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
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, 900 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$450 per day for accommodation, subject to the stipulated available Benefit limit per Option.
BENEFIT REWARDS Low claiming threshold levels
1. Each Dependant is allocated with a threshold value per annum. Should you claim less than your threshold value as at 31 December of each year, the remaining balance in your threshold will be transferred to your Benefit Wallet. Principal Member N$ 1, 700
Adult Dependant N$ 1, 200
Child Dependant N$ 600
(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.
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.