As part of the Nammed additional service offering, the Benefit Bank provides a monetary incentive for members in return for managing your claims responsibly. The incentive will be in the form of the monetary balance between an allocated threshold amount and the day-to-day benefit. This amount will accrue as a credit amount in your Benefit Bank to be used for medical and related expenses that are not normally covered by the Nammed medical aid fund. This amount will then be transferred, following the run-off period, into the Benefit Bank account, which can be used to pay for medical expenses.
A positive balance in your Benefit Bank account may be used for:
- Routine medical costs (in and out of hospital)
- Outstanding co-payments
- Any medical expense usually excluded as per the fund rules, on condition that:
- Medical treatments be provided by a registered healthcare professional
- Medical products have a valid NAPPI code
- Sunglasses, whether or not prescribed by an optometrist or ophthalmologist
- The difference between the actual costs and the NAMAF Benchmark tariffs for medical services covered by the rules of the fund
- Medical aid contributions: For employer groups, any request for a contribution holiday must be pre-approved by the employer
- Claims for conditions, procedure or medicines excluded by the rules, including exclusions
The Benefit Bank limits will be determined according to family size up to a maximum of main member and five dependents (M+5). All active and paid-up members on Nammed medical aid fund will receive Benefit Bank threshold limits as specified in the brochure per option. Should the member deplete the Benefit Bank threshold amount for the current year, then no Benefit Bank amount will be carried over to the accumulated Benefit Bank account.
Should the designated claims be less than the Benefit Bank threshold limit at the end of the fund financial year, then the balance remaining will be carried over to the Benefit Bank account on 01 May annually.
Should the member resign from the fund, then the member will forego the positive balance in the accumulated Benefit Bank account. The balance in the Benefit Bank will then be transferred to the Nammed medical aid fund reserves.
Upon resignation of a member from an employer group, if the member elects to continue as a private member or part of another employer group on Nammed medical aid fund, then the positive accumulated Benefit Bank account will be transferred with the new membership number without forfeiture of the accumulated Benefit Bank account.
Upon the death of the principal member, any positive accumulated Benefit Bank account amount, due to the member will be transferred to his or her dependants, if the dependants continue membership with the fund. If the dependants of such deceased member resign from the fund, then the positive balance of the Benefit Bank account will be forfeited and transferred to the fund’s reserves. Each transaction will be separately authorised by the member for payment of claims.
Any positive accumulated Benefit Bank amount that is left over from the previous year will be carried over to the new benefit year and the member will not lose these benefits as long as the member is an active and paid-up member. Requests for contribution holidays must be pre-approved in advance and one month’s notice must be given to the fund. Each transaction will be separately authorised by the member for payment of claims. Positive accumulated Benefit Bank accounts cannot be transferred to Trauma, Core and Basic options. Should the member request for an option change the member will forfeit the positive accumulated Benefit Bank amount.
Should a member join the fund or downgrade options during the course of the year, pro-rating of benefits will apply regards to Benefit Bank threshold limits. Upon suspension or cancellation of a member, the positive balance in the accumulated Benefit Bank account will be transferred to the fund’s reserves.