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TOPAZ

OVERALL ANNUAL BENEFIT Unlimited According to Defined Primary Healthcare Protocols

CATEGORY A: Primary Healthcare Benefits

% Agreed tariffs with Network Administrator

(DHS)

1. Nurse

100%

Registered Nurse

1.1 Consultations Unlimited (N$20 per visit)

1.2 Medication / Injections Unlimited(According to Topaz & Topaz Plus Medicine Formulary)

1.3 Procedures Unlimited

2. General Practitioner

100%

According to defined protocols through network service providers only

2.1 Consultations Unlimited

2.2 Acute Medication/InjectionsUnlimited

(According to Topaz & Topaz Plus Medicine Formulary) 2.3 Chronic Medication/Injections

Subject to registration with the Network Administrator (DHPS)

2.4 Procedures Unlimited

3. Pathology 100% Specified tests

4. Radiology 100% Unlimited long bones, chest and traumaExcluding MRI & CT Scans

5. Dentistry 100% Extractions & fillings only

6. Ultrasound 100% 2 per pregnancy and 2 per member per annum(pre-authorisation required)

Category B: HIV/AIDS Treatment and Other Specified Conditions

% Agreed tariffs with Network Administrator

(DHS)

Unlimited according to defined protocols

7. HIV/AIDS Treatment

100%

As per national guidelines for antiretroviral therapy

7.1 Consultations Unlimited

7.2 Medication (Acute & chronic including vitamins & supplements) Unlimited

7.3 Pathology Unlimited

7.4 Counseling (pre-, post & adherence) 3 Sessions

7.5 Rape Cover As per national guidelines for antiretroviral therapy

8. Sexually Transmitted Diseases According to National Guidelines

Category C: Hospitalisation Benefit Private Wing of State Hospital

Planned procedures: waiting period of 6 months after joining; Emergency cases: immediate cover

Overall Annual Limit % Tariff Unlimited

9. Hospitalisation

100%

9.1 Accommodation and Theatre Overall Annual Limit

9.2 Blood Transfusions Overall Annual Limit

9.3 Intensive and High Care Overall Annual Limit

9.4 Medicine, Fixed Tariff Procedures, Hospital Apparatus and To Take Out Medicine Overall Annual Limit (7 days supply only)

9.5 Radiology & Pathology (In-hospital) Overall Annual Limit

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10. General Practitioners & Medical Specialists (In-Hospital Services) (AHB Cover Excluded) 100% N$25 000 per Family

11. Other Healthcare Providers No benefit

12. Maternity Unlimited hospitalisation in state hospital(GPs and Specialists limited to sub-limit 13)

13. Ambulance Services

100%Unlimited13.1 Emergency Road Ambulance (Coverage Territory –

Angola, Botswana, Kenya, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Tanzania, Zambia and Zimbabwe)

13.2 Ambulance/Inter-hospital Transfer (subject to pre-approval) N$550 per member

Contribution Tables

Topaz Individual Contributions Topaz Group ContributionsMain Adult Child 04+ Main Adult Child 04+516 456 160 411 354 135

Detailed Benefits: These rules apply for Topaz.

Service AvailabilityPlease note that all benefits on Topaz are only available through registered Topaz Network Health Professionals.

Please visit our website, www.nmcfund.com for the updated Topaz Network Health Professionals list.

PathologyThe following tests are pre-approved and can be done at the discretion of the treating general practitioner:

• Albumin• ALP• ALT• Amylase• AST• Bilirubin Direct• Bilirubin Total• CD4 cell count• Cholesterol• CKMB; Trop T; Trop I• Creatine• CRP• ESR• Estimated GFR• FBC• GGT• Glucose• HBsAg

• HIV antibodies-Elisa (HIV-DNA PCR is specifically excluded).• HIV viral load, according to treatment guidelines• H-Pylori faecal antigen • Malaria smear• Potassium• Pregnancy test• Protein Total• PSA Total• RF• RPR• Stool MC&S• Stool parasites• Swabs• TB microscopy• Urea• Uric acid• Urine MC&S

Other tests are excluded, but will be considered if a motivation is provided by the treating GP, and on the sole discretion of the DHS Medical Director.

RadiologyGeneral Radiology excluding MRI and CT scans.

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.UltrasoundsUltrasounds are limited to 2 sonars per pregnancy and 2 sonars per member per annum. Pre-authorisation required, except in emergencies.

DentistryBasic dentistry is covered, including extractions, fillings and oral hygiene. Benefit for basic dentistry specific to pain and sepsis treatment and two oral hygiene visits per beneficiary. The following treatments are covered:

• Consultation• Examination for a specific problem• Intra-oral radiographs, per film• Infection control• Sterile tray• Local anaesthetic• Polishing only• Scaling• Fluoride treatment• Fissure sealant – per tooth• Extraction 1st tooth

• Extraction 2nd Tooth• Full upper or lower dentures• Amalgam – one surface• Amalgam – two surface• Amalgam – three surface• Amalgam – four or more surface• Resin – one surface, anterior• Filling front tooth (small)• Filling front tooth (medium)• Filling front tooth (large)

HIV/AIDS A. Treatment – Unlimited: According to the National Guidelines for

antiretroviral therapy (2014).B. Counselling – 3 sessions pre, post and adherenceC. Pathology – baseline and monitoring laboratory tests as

detailed in the national guidelines for antiretroviral therapy.D. Rape Cover – Covered according to the defined protocol in the

National Guidelines for antiretroviral therapy.• Tenofovir (300 mg) plus Lamivudine (300 mg) fixed dose

combination daily, Plus Lopinavir/ritonavir combination BD for 28 days.

• Plus other supportive actions as detailed in the above guidelines.

Medicine FormularyTopaz only covers medication as specified in the Topaz and Topaz Plus Medicine Formulary available on our website, www.nmcfund.com