Track A Claim Made Through Your Nammed Medical Aid Option
We have made the process for tracking your claims as simple and straightforward as possible. If you’ve made a claim through your Nammed medical aid option, please familiarise yourself with the below information.
If you have any further questions, please don’t hesitate to contact us.
When Will My Claim Be Paid?
Nammed medical aid fund makes two payment runs every month to both healthcare providers and members. As a member, you will receive a monthly statement containing the details of all payments made. Nammed will pay any benefit due to a member or service provider within thirty (30) days of receiving the claim relating to the benefit.
Nammed may, by mutual agreement with any supplier or group of suppliers of a service, pay the account or the benefit to which the member is entitled in respect of a service rendered, directly to the supplier.
Where Nammed has paid an account or portion of an account, or any benefit to which a member is not entitled, whether payment is made to the member or to the supplier of a medical service, Nammed will recover the amount overpaid or paid incorrectly from the member or the service provider.
Understanding Medical Aid Claim Terms
Day-To-Day Benefits
Day-to-day benefits cover medical expenses incurred outside the hospital and these benefits are included in all Nammed medical aid options except the Trauma option. Day-to-day expenses are covered at 100% of NAMAF tariff and are limited to the annual day-to-day limits as set out in the brochure for each option.
Major Medical Expenses
Major medical expenses (MME) are most often associated with hospitalisation. All the options, except for the Basic option, cover MME at 100% of NAMAF tariff. All surgical procedures performed in-hospital are covered at 225% of NAMAF tariff and are subject to the overall annual limit.
Co-Payments
Some members may have co-payments on day-to-day and MME. These co-payments are derived from the service provider fee being above NAMAF tariff
Side Pannel
Medical Aid Options
Nammed
Basic
The Basic option provides reasonably-priced, primary healthcare services to the lower-income group. (Maximum monthly salary may not exceed N$7 000).
N$673
Overall Annual
Benefit of
Unlimited (State Facility)
Nammed
Trauma
The Trauma option offers comprehensive benefits for major medical expenses normally associated with hospitalisation. Ideal for members wishing to cover hospital costs only.
N$2298
Overall Annual
Benefit of
N$3 000 000.00
Nammed
Active
The Active option offers benefits associated with hospitalisation and day-to-day medical expenses. This option will cater for young, single people and smaller, healthy families.
N$1677
Overall Annual
Benefit of
N$1 500 000.00
Nammed
Essential
The Essential option is generally suited for the healthier person or family between 36 and 55, who seeks greater benefits than the Active option without needing as much as the Standard option offers.
N$3467
Overall Annual
Benefit of
N$2 200 000.00
Nammed
Standard
The Standard option offers benefits associated with hospitalisation and day-to-day medical expenses. This option is well-suited for the middle-to-higher-income earners who wish to enjoy peace of mind.
N$3985
Overall Annual
Benefit of
Unlimited
Nammed
Comprehensive
The Comprehensive option offers benefits associated with hospitalisation and day-to-day medical expenses. Ideal for members wishing to cover their medical costs to the greatest extent possible or whose health risks may be perceived as high.
N$5246
Overall Annual
Benefit of
Unlimited
Life Stages
18-25
Starters
- Beginning Employment.
- Low - Medium Income,
- Low Health needs,
- For unexpected medical needs.
26-35
Nest Builders
- Seek value rather than cheapest option.
- Need cover for expected medical needs for the young family..
36-55
Mid-Lifers
- Middle to High income levels,
- Medical Aid is a routine monthly expense,
- stable health needs,
56-60
Grey Foxes
- Moving towards retirement,
- Health risks and prevalence of chronic diseases increasing,
61+
Wise Owls
- Members approaching or in retirement,
- Increased prevelance of chronic diseases,
- Greater importance of extent of cover for major medical events like knee & hip replacements.