Guidelines

BEDSIDE SUPPORT SERVICE    BENEFIT BOOSTER    CHRONIC MEDICATION REGISTRATION    CLAIM SUBMISSION PERIOD    EX-GRATIA POLICY    HOSPITALIZATION PRE-AUTHORIZATION    

The Additional Hospital Benefit Cover (AHB) pays the excess of NAMAF Tariffs for General Practitioners and Medical Specialists should a member or dependant be hospitalized. The AHB is applicable to NMC only. The funds pay 100% of NAMAF Tariffs PLUS a maximum of 125% additional cover for any excess of the NAMAF tariff that the General Practitioners and Medical Specialists may charge.


When consulting a doctor (General Practitioner or Medical Specialists) prior to hospitalization, a member should ask the following:

1. Ask the doctor if he/she is claiming directly from the Fund. If not, the member should pay the doctor directly and submit the claim / invoice with proof of payment.

2. Ask the doctor if he/she has an AHB contract with the Fund. If the doctor has an AHB contract, it means that he/she is registered to claim directly to the Fund but can only charge the NAMAF tariff + maximum of 125%.

3. If a doctor is contracted-in with AHB and yet you received an excess to pay, it means the doctor is charging more than the NAMAF Tariff + 125%. Please report the doctor to Methealth and one of our Client Service Advisors will engage with the doctor.


SUPPORTING DOCUMENTS

NMC	Psemas
AHB Form (member) AHB Form (HP)