There are two options: Core and Plus. Plus includes additional benefits that are not available on Core.

• Core: In-hospital tariff shortfalls (up to 200% of NAMAF tariff).
• Plus: Higher in-hospital tariff shortfalls (up to 250% of NAMAF tariff) plus out-of-hospital shortfalls, co-payment cover, oncology cover, accidental death/disability, and premium waiver (benefit rules apply).

If a specialist charges more than what your Medical Aid Fund pays in hospital, Gap Cover can pay the difference up to the plan limit (Core up to 200% of NAMAF tariff; Plus up to 250% of NAMAF tariff).

Core: Not covered.
Plus: Covered up to 250% of NAMAF tariff (benefit rules apply).

Yes. Plus includes co-payment cover up to N$12,000 per event, applicable to specialised radiology, gastroscopies and colonoscopies (benefit rules apply). Core does not include this benefit.

Core: Not covered.
Plus: Oncology cover up to N$500,000 per family per year, typically after Medical Aid depletion / where your fund benefit is insufficient (Medical Aid protocols apply).

Plus includes an accidental death/permanent disability lump sum benefit of N$30,000. Core does not include this benefit.

On Plus, if the main insured dies or becomes disabled (as defined in the policy), premiums can be waived for up to 3 months so cover can continue for dependants (terms apply). Core does not include this benefit.

Yes. An overall annual limit applies per family. The limits are defined per plan and shown on your policy schedule.

Only Namibian citizens or legal permanent residents can be covered under this policy (eligibility rules apply).

• Principal member: entry age 18 to 65.
• Adult dependant: entry age 18 to 65.
• Children: entry age 0 to 20; cover can continue up to age 25 (and ends earlier if the policy ends or the child marries).

Exact rules are set out in the policy terms.

You can cover a partner/spouse (one), adult children (up to five), and child dependants (up to five), subject to the policy rules and age limits.

Yes:

• Accidental causes:0 months waiting period.
• All embedded benefits (excluding pre-existing):3 months.
• Pre-existing conditions:12 months.

Waiting periods and definitions apply as per the policy wording.

A pre-existing condition is generally a condition that occurred in the 12 months before cover starts. In those cases, a 12-month waiting period applies after cover starts (policy terms apply).

Premiums are paid monthly via debit order.

Premiums are due on the 1st of every month following the commencement date. Cover commences on the 1st of the month in which the first premium is received following the sale of the policy. Pro-rata premiums are not allowed.

A 2-month grace period applies. The policy will lapse if 3 consecutive premiums have not been collected.

Yes, in certain cases (for example, if the policy ended due to non-payment and you restart within the allowed period). Restart is effective on the 1st of the month after you pay the total amount due (terms apply).

Yes. You can upgrade by moving to a higher plan; waiting periods may apply to the increased benefits. You can also downgrade; waiting periods generally do not apply to the reduced benefits (policy rules apply).

If you provide proof of existing cover and proof it has been cancelled, waiting periods may be waived and cover continued on the prior basis. If you buy more cover or add additional lives, normal waiting periods apply to the increased benefits.

If a partner/adult dependant is insured, they may opt to continue cover (for themselves and remaining insured lives) within 3 months of the policy ending due to death, subject to arrears being paid. No waiting periods apply on continuation.

The policy is intended for Namibian residents. If country of residence is not Namibia, cover may be declined. Cover may be extended outside Namibia for a holiday of up to 90 days (terms apply).

Yes — you can nominate up to 6 beneficiaries for death/accidental proceeds, and beneficiaries must be 18+. If no beneficiary is nominated (or they are not alive at claim time), the policy sets out an order of eligible close family claimants.

No. If the premium payer is not the policyholder, they do not accrue rights in the policy. Permission is required to debit the payer’s account.

No. Policies cannot be made paid-up and there are no surrender values.

No — cession is not allowed on any benefit.