Premiere Care Medical Aid Package
OAL Unlimited at State Hospital | Per family N$ 386,000 at Private Hospital | From N$940/Month
Premiere Care is the start of your medical aid journey; the medical aid essential for you as you start your personal life path. Premiere Care gives you access to hospital, day-to-day and complimentary benefits.
Hospital Benefit
Unlimited at State facility
Doctor Service
N$ 9, 800 per year
Optical Benefit
N$ 1000 per year
Dental Benefit
N$ 5, 600 per year
 Hospital Benefits |
TARIFF % | BENEFITS |
| TOTAL ALL-INCLUSIVE OVERALL ANNUAL LIMIT | State Hospitals: Unlimited Private Hospitals: N$ 386, 000 per family | |
| HOSPITAL BENEFIT GROUP (Subject to clinical risk management protocols) | N$ 386, 000 per family | |
| Private hospital (Approved surgical and medical admissions only) (Including medicines, materials, hospital apparatus & Take-Out Medication, limited to a 7 day supply). | 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 & Take-Out Medication, limited to a 7 day supply). | 100% | Unlimited |
| Consultations including treatment and services. | 100% | Part of the sub-limit in a Private hospital and unlimited in State facilities |
| Sub-acute facility ward fees. (Admission in lieu of hospitalisation). | 100% | Part of the Overall Annual Limit |
| Blood transfusion. | 100% | |
| Radiology and Pathology. | 100% | |
| Physiotherapy. | 100% | |
| Post-Operative Extended Benefit (Following major surgery). Part of pre-authorisation and clinical protocols. | 100% | No benefit |
| 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 - Selective surgical and endoscopic procedures, circumcisions. Inclusive benefit - Admissions, surgery, treatment and services. Part of pre-authorisation and clinical protocols. | 100% | 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$ 8, 700 per family N$ 4, 400 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$ 17, 200 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. | 100% | Part of the sub-limit |
| DENTAL AND ORAL SURGERY | No benefit | |
| Admission. | State facilities only No benefit in private hospitals | |
| 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 | N$ 56, 700 per family | |
| Admission. | 100% | Part of the sub-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. | 100% | |
| Cataract surgery only after one year membership. 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 | No benefit | |
| Admission. | State facilities only No benefit in private hospitals | |
| Reconstructive Surgery - After two years membership. (All-inclusive benefit - admissions, surgery, treatment and services). Part of clinical protocols. | ||
| ALTERNATIVE SERVICES | No benefit | |
| In- and Out-of-Hospital Benefit including occupational therapy, private nursing, palliative care (end stage terminal diseases) and frail care. | State facilities only No benefit in private hospitals | |
| MENTAL HEALTH | No benefit | |
| 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. | State facilities only No benefit in private hospitals | |
| INTERNAL PROSTHESIS | No benefit | |
| Internal prosthesis - example: knee / hip / pacemakers. Part of pre-authorisation and clinical risk management protocols. | State facilities only No benefit in private hospitals | |
| TRAUMA TREATMENT | No benefit | |
| Organ transplant, acute renal and peritoneal dialysis. (In- and Out-of-Hospital). | State facilities only No benefit in private hospitals | |
| Oncology (Including basic chemo and radiation treatment) (In- and Out-of-Hospital). | ||
| Specialised chemotherapeutic and high cost medication treatment. Part of clinical protocols and applicable Medical Aid Fund Rules. | ||
| Motor Vehicle Accidents (MVA). | Part of the Overall Annual Limit | |
| IUD DEVICES (Intrauterine contraceptive device) | No benefit | |
| Placement of IUD (including device and procedure) | No benefit | |
| 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, 700 per family |
| HIV / AIDS pathology. | 100% | N$ 13, 000 per family |
| HIV / AIDS medication. | 100% NRP | N$ 43, 700 per family |
| HIV counselling. | 100% | N$ 5, 100 per family |
 Day To Day Benefits |
TARIFF % | BENEFITS |
| PROFESSIONAL SERVICES | N$ 9, 800 per family N$ 4, 900 per beneficiary | |
| 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 |
| General Practitioner telephone consultations. | 100% | Part of Professional Service limit |
| General Practitioner / primary and specialist procedures in rooms including equipment, materials and injections. | 100% | Part of Professional Service limit |
| Psychiatric and Psychology consultations and treatment. | State facilities only | |
| Radiology | 100% | Part of Professional Service limit |
| Pathology. | 100% | Part of Professional Service limit |
| 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. | State facilities only | |
| EXTERNAL PROSTHESIS AND MEDICAL APPLIANCES | No benefit | |
| Prosthesis external - Artificial arms / legs / eyes every two years. Part of pre-authorisation and approval. | State facilities only | |
| Special external medical appliances - Wheelchairs every three years; hearing aids apparatus every two years. Part of pre-authorisation and approval. | ||
| General external medical appliances - Including glucometers, blood pressure monitors, stockings, braces etc. Part of pre-authorisation and approval. | ||
| OPTICAL BENEFIT | N$ 1, 000 per family N$ 680 per beneficiary | |
| Eye tests. | 100% | Part of the sub-limit |
| Lenses / contact lenses. | 100% | Part of the sub-limit |
| Frames, once every two years | 100% | Part of the sub-limit |
| DENTISTRY BENEFIT | N$ 5, 600 per family N$ 2, 700 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% | Plastic dentures every two years |
| MEDICATION BENEFIT | N$ 7, 200 per family N$ 3, 600 per beneficiary | |
| 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. | No benefit | |
| Homeopathic medication. | No benefit | |
| Chronic Medication - Preferred and non-preferred. Subject to a defined list of conditions available on the RMA website per Benefit option. | 100% 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. | 100% | Part of the sub-limit in private hospitals Unlimited in State facilities |
| Gynaecology / obstetric - Out of hospital | 100% | |
| Maternity scans. | 100% | 2 scans per beneficiary |
| Antenatal visits | 100% | 12 visits per beneficiary |
| Amniocentesis - AHB excluded. | 100% | Part of the sub-limit in Private hospitals Unlimited in State facilities |
| Neonatal ICU / ward fees. | 100% | |
| Paediatrician visits - Postnatal. | 100% | |
 PREVENTATIVE BENEFITS |
TARIFF % | BENEFITS |
| PREVENTATIVE BENEFITS | N$ 10, 500 per family | |
| PREVENTATIVE BENEFITS (Members may earn benefit rewards for participation) | Part of Preventative Benefit | |
| Blood sugar test, cholesterol test, BMI and blood pressure measurement. (Finger prick tests only) | 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 - To enhance the scope of chronic disease benefits, to incorporate structured and closely monitored early screening for non-communicable diseases, along with the implementation of preventive care treatment plans. | 100% | Part of Preventative Benefit. In accordance with an approved clinical treatment plan, for routine follow-up tests when required. |
| PREVENTATIVE BENEFIT REWARDS (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 Preventative Benefit | |
| 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 - 12 years. | 100% NRP | Vaccinations for children 0 - 12 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 | No benefit | |
| Transport cost when referred for specialist services not available in the area of residence. | No benefit | |
| 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$ 700 Adult Dependant N$ 450 Child Dependant N$ 200 | |
| (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, will earn additional Benefit Wallet rewards, this includes early registration on the maternity programme and additional rewards for normal births. | ||
| BENEFIT WALLET | ||
| Accumulated Benefit Wallet Benefits can be used for purchasing any medical treatment and services in terms of the Medical Aid Funds Act, should the member pay first and claim back from the Benefit Wallet, it needs to be done within the 8-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. Accumulated Benefit Wallet Benefits will automatically be used for the payment of medication levies. Unused Benefits in your Benefit Wallet will roll over year on year. | 100% of cost | Subject to availability of Benefit Wallet Benefits, medical treatment and services obtained from a registered medical facility. |
| Benefit Wallet Benefits can be accumulated through: | ||
| • Participation in Wellness Day initiatives • Participation in Lifestyle and fitness events • Preventative testing • Early registration for the maternity programme • Normal births | ||
| LONGSTANDING MEMBERSHIP REWARDS | Group Rate 1 Contributions | |
| An Individual 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. | ||