PSEMAS Complimed

PSEMAS Complimed is a suite of insurance policies specifically designed to complement your medical aid (PSEMAS), offering enhanced coverage that bridges the gap between existing PSEMAS benefits and actual medical costs. This range provides peace of mind and essential financial protection, ensuring that members have full healthcare coverage when faced with private hospital admissions or outpatient procedures. With PSEMAS Complimed, members can confidently access private healthcare, focusing on recovery without the financial stress.

PSEMAS Complimed includes:

Complimed Gap, which is a gap insurance policy that bridges the financial gap between what your medical aid covers and excess of tariff treatment costs in private hospitals, in other words, it complements your existing medical aid, ensuring peace of mind by covering in-hospital excess of tariff costs at the insured rate up to the benefit limit, including surgeries, maternity care, trauma-related treatments and more. Complimed Gap provides up to N$2.5 million in gap coverage per family, allowing policyholders to access the care they need without unexpected expenses. The agreed tariff is based on the Prosperity Benchmark Tariff (PBT) plus 225% and in-hospital cover is subject to policyholder validation and insurance protocols.

Doc-Gap, available as an optional top-up for Complimed Gap policyholders, enhances outpatient coverage by covering the difference in tariff between what PSEMAS pays and the tariff that doctors charge, at the insured rate. This benefit applies to a wide range of essential services, including in-room procedures, optometry, dentistry and more. By covering these outpatient costs, Doc-Gap helps members access day-to-day healthcare without worrying about additional expenses. Doc-Gap provides coverage for up to six general practitioner visits per person and up to four dental consultations per person each year. Any additional visits are covered through the MEDBUX benefit.

Hospicash 50 and Hospicash 100, which can be taken out as a top-up to your existing Complimed PSEMAS gap cover, are optional benefits for Complimed Gap policyholders, providing cash payouts to help cover unforeseen non-medical expenses incurred during hospital stays of three or more continuous days in private hospitals in Namibia. Each hospital admission is treated as a separate event, with Hospicash 50 offering a maximum payout of N$15,000 per event and Hospicash 100 offering up to N$30,000 per event. These payouts can help cover unexpected costs associated with hospitalisation, such as accommodation for family members or transportation. Policyholders can receive up to N$50,000 per year with Hospicash 50 or up to N$100,000 per year with Hospicash 100, with payouts available for each hospitalisation event.

ADDITIONAL BENEFITS: EMERGENCY AND TRAVEL COVERAGE

Complimed Gap includes emergency evacuation services within Namibia, South Africa and defined SADC region, covering both road and air ambulance costs. For policyholders travelling abroad, international travel cover provides emergency medical assistance and evacuation support. This includes medical treatment, inter-hospital transfers, repatriation and coverage for the return of children or mortal remains if needed. The benefit provides coverage up to N$10 million per person.

Additionally, Hospicash 50 and Hospicash 100 policyholders gain access to Rescue Me, which provides road ambulance services within Namibia amounting to N$500,000 per family and a funeral plan. To explore your coverage options or to upgrade, SMS “PSEMAS” to 999 555. Ts & Cs apply. All policies are underwritten by Prosperity Life.