JOINING THE FUND
Get in touch with Renaissance Health Medical Aid Fund. You will be provided with a membership application form to complete and return for assessment. When your application is approved, you will be informed accordingly. Please note that we may ask for a full medical examination. It is important to declare any existing conditions on your membership application. If you don’t, it may be considered as false information and your membership may be terminated.
The Fund’s benefit year is from 1 January to 31 December. Any member who joins during the benefit year will receive proportionate (prorated) benefits. That means that your annual benefit limits will be calculated according to the number of months left in the benefit year.
We provide cover for a range of conditions. Exclusions are applicable on medical conditions which a Medical Aid Fund is legally permitted to exclude from its cover. Please ensure that you declare your complete medical history when applying for membership as pre-existing conditions could be excluded from your cover, so you may have to pay for these costs from your own pocket. You will receive written notification on any exclusions when you join.
In terms of the Medical Aid Fund Act no person shall be admitted as a member of more than one registered fund, being either as the principal member or as a dependent.
Pregnancy is excluded for 12 months if you are not a continuation member and join as an individual/private member.
Renaissance Health does not discriminate against people with HIV/AIDS. You, and any dependants with HIV/AIDS, can join the Renaissance Health ‘Health is Vital’ programme for HIV management, and benefit from medical treatment and medication.
Your benefits are determined by the product option you select. The maximum amount of benefits depends on the product’s overall annual limit. You will find detailed product descriptions on pages 6-19.
Complimentary Benefits provide additional cover for a range of medical services. We pay claims for Complimentary Benefits to make your day-to-day benefits last longer. These include health screenings, disease management programmes, travel assistance, contribution protection and more.
MEMBERSHIP
The oldest member of your family will be classified as the principal member. Principal members must join before the age of 60. This Rule is subject to the discretion and approval of the Board of Trustees.
You may have child dependants up to the age of 25, after which they will become principal members themselves. This is regardless whether they are studying or not. They may continue to be your dependent up to the age of 25, as long as they are financially dependent on the main member.
Dependants (spouse and children) who are registered with the Fund at the time of the principal member’s death can stay on as members, and should inform us in writing within 30 days of the principal member’s death.
Funds that are not used by you or other members of Renaissance Health, are reinvested to provide healthcare cover for the future. Healthy, young and low claiming members cross-subsidise the medical expenses of older, sick and high claiming members. Unused benefits are not rolled over to the following benefit year.
In this case, you have the option to extend your day-to-day benefits with Benefit Builders. If your product does not qualify for Benefit Builders you will have to pay medical expenses from your own pocket. We encourage you to keep track of benefits online, and with your statements, so that you always have benefits available.
You can change your product once a year, effective 1 January. For this reason it is important to choose the correct product to cover you and your family’s health care needs for the following year. For advice on choosing the correct product option.
Your benefits can be used by yourself and any dependants you registered with Renaissance Health. You cannot transfer benefits between beneficiaries on the Fund.
When you contact Renaissance Health, you will be given a CRM number, which is used to track our services. Keep this CRM number as a reference when you call, email or visit. It will save you time when contacting Renaissance Health.
As part of your complimentary benefits, you are entitled to register for our chronic/disease management programme. Contact us to get an application form. We will request a treatment plan from your doctor to accompany your application on specified conditions. Once registered, you will receive a confirmation letter containing a list of preferred medication for your condition. Using preferred medication will lower your co-payments. Please notify us if there are any changes to the prescribed medication for your condition.
If a doctor or specialist refers you or a dependant for hospitalisation, please call us 48 hours before you are admitted to confirm your benefits for admission. Emergency admissions may be authorised within 48 hours or on the first business day following the admission. You will be provided with an authorisation number to approve admission and services.
If you or a dependant have a medical emergency immediately call E-Med Rescue 24 on 081 924 (inside Namibia) or +264 61 2999 924 (outside Namibia) for emergency medical evacuation to the nearest appropriate hospital.
You may claim for treatment in South Africa. Renaissance Health has agreements with some South African Healthcare Providers. If the Healthcare Provider does not accept Renaissance Health, the amount is payable by you to be claimed back. Ask the Healthcare Provider to call + 264 61 2999 736 for assistance.
If you are referred for treatment that is not available in your town of residence, in or outside of Namibia, we offer financial assistance for travel expenses. Please obtain pre-authorisation and see pages 6-19 for product specific cover.
The Fund also covers emergency evacuation, repatriation, medical treatment and return of mortal remains (SADC) as part of your Complementary Benefits.
We provide cover up to N$ 10 million for medical emergencies when you travel internationally for a maximum period of 3 months. For cover please register with us before your trip. You will need to supply the following for registration:
- Your trip schedule (dates & locations)
- Confirm if any of your family members will accompany you
- Copies of passports
CLAIMS
Please provide your membership number when receiving medical services. This will enable the Healthcare Provider to see what benefits you have available.
Contracted-in providers will claim directly from Renaissance Health. If the provider charges above NAMAF tariff the difference will result in a co-payment that you need to settle out of your pocket. If you use a Healthcare Provider that is not contracted-in, you will settle the amount and claim for reimbursement from Renaissance Health Medical Aid Fund.
To claim a refund please submit a detailed account, or receipt/invoice with a ‘paid’ stamp to your nearest Prosperity Health office or e-mail it to rhmafclaims@prosperitynam.com.
If the claim is correct and acceptable for payment, it will be paid within 30 days. It is important to note that claims with incomplete details cannot be processed.
In terms of legislation, no refunds will be made for medication bought in retail shops, since Funds in Namibia are only allowed to pay providers with a valid practice number registered with NAMAF.
All claims should be submitted as soon as possible, but no later than four months from the date of receipt of service. You forfeit your right to claim a reimbursement in respect of claims submitted late.
A statement showing full particulars of transactions, including amounts charged or benefits paid per service will be supplied via post or email.
You can register for access to our member portal to verify the status of your claims. You will also receive a SMS confirming payments made to you or your Healthcare Provider.
These notification services do not replace the claims statement, but allow you to follow the processing of your claims.
Please notify us if your postal address, email address or cell phone details change, to ensure that you receive our communication.
When you receive your claim statement, please verify that:
– All your claims have been processed. It is the member’s responsibility to make sure that all claims are paid.
– All the claims reflected are for services provided to you and / or your registered dependants.
– The amount paid to you or the Healthcare Provider is correct.
– Any claims that were not paid due to rejections, i.e. benefits exceeded, excess of NAMAF tariff, exclusions etc. are reflected correctly.
– If you see any discrepancies or have any queries, please contact the Client Service Department at +264 61 2999 736 or email rhmafinfo@prosperitynam.com immediately.
If your membership card is lost or stolen, please inform us immediately. If you fail to do so, you could be held personally responsible for any expenses incurred due to fraudulent use.
The use of a membership card by any person other than the member or his/her registered dependants is against the law and could result in the immediate suspension of your membership and benefits.
