Questions About Nammed? Review Our Frequently Asked Questions

Questions About Nammed? Review Our Frequently Asked Questions

Claims

Nammed Medical Aid Fund has two payment runs per month to Healthcare Provider and Members. Members will receive a monthly statement containing details of all payments made. The Fund shall pay any benefit due to a member or service provider within thirty (30) days of receipt of the claim pertaining to such benefit. The Fund may, by mutual agreement with any supplier or group of suppliers of a service(s), pay the account or the benefit to which the member is entitled in respect of a service rendered, directly to such supplier(s). Where the Fund 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, the amount of any such overpayment or incorrect payment shall be recoverable from either the member or the service provider, by the Fund.

Day-to-Day benefits cover medical expenses incurred outside the hospital and these benefits are included in all the 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 (MME) are most often associated with hospitalization. All the Options, except for the BASIC Option, cover MME at 100% of NAMAF tariff and all surgical procedures performed in hospital are covered at 225% of NAMAF tariff and are subject to the overall annual limit.

Some Members may have do-payments on day-to-day and major medical expenses.  This co-payment derives from the service provider fee being above NAMAF tariff

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