Premiere Care Medical Aid Package

OAL Unlimited at State Hospital | Per family N$ 368,000 at Private Hospital | From N$855/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. Premiere Care also offers its members a provider network option, giving you access to a wide network of service providers. Click below for the Network Provider List.

Hospital Benefit

Unlimited at State facility

Doctor Service

N$ 9, 300 per year

Optical Benefit

N$ 950 per year

Dental Benefit

N$ 5, 300 per year

Hospital Benefits TARIFF % BENEFITS
TOTAL 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 (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 (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
Consultations including treatment and services. 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, 300 per family
N$ 4, 200 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$ 16, 300 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$ 54, 000 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, including breast reductions. (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
"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
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
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).
IUD DEVICES (Intrauterine contraceptive device) No benefit
Insertion 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, 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$ 9, 300 per family
N$ 4, 700 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$ 950 per family
N$ 630 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, 300 per family
N$ 2, 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% Plastic dentures every 2 years
MEDICATION BENEFIT N$ 6, 900 per family
N$ 3, 400 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. 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%
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 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 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
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.
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.