Frequently Asked Questions
Claims

Please provide your membership number when receiving medical services. This will enable the Healthcare Provider to see what benefits you have available.

Contracted-in providers will claim directly from Renaissance Health. If the provider charges above NAMAF tariff the difference will result in a co-payment that you need to settle out of your pocket. If you use a Healthcare Provider that is not contracted-in, you will settle the amount and claim for reimbursement from Renaissance Health Medical Aid Fund.

To claim a refund please submit a detailed account, or receipt/invoice with a ‘paid’ stamp to your nearest Prosperity Health office or e-mail it to rhmafclaims@prosperitynam.com.

If the claim is correct and acceptable for payment, it will be paid within 30 days. It is important to note that claims with incomplete details cannot be processed.

In terms of legislation, no refunds will be made for medication bought in retail shops, since Funds in Namibia are only allowed to pay providers with a valid practice number registered with NAMAF.

All claims should be submitted as soon as possible, but no later than four months from the date of receipt of service. You forfeit your right to claim a reimbursement in respect of claims submitted late.

A statement showing full particulars of transactions, including amounts charged or benefits paid per service will be supplied via post or email.

You can register for access to our member portal to verify the status of your claims. You will also receive a SMS confirming payments made to you or your Healthcare Provider.

These notification services do not replace the claims statement, but allow you to follow the processing of your claims.

Please notify us if your postal address, email address or cell phone details change, to ensure that you receive our communication.

When you receive your claim statement, please verify that:

– All your claims have been processed. It is the member’s responsibility to make sure that all claims are paid.
– All the claims reflected are for services provided to you and / or your registered dependants.
– The amount paid to you or the Healthcare Provider is correct.
– Any claims that were not paid due to rejections, i.e. benefits exceeded, excess of NAMAF tariff, exclusions etc. are reflected correctly.
– If you see any discrepancies or have any queries, please contact the Client Service Department at +264 61 2999 736 or email rhmafinfo@prosperitynam.com immediately.

If your membership card is lost or stolen, please inform us immediately. If you fail to do so, you could be held personally responsible for any expenses incurred due to fraudulent use.

The use of a membership card by any person other than the member or his/her registered dependants is against the law and could result in the immediate suspension of your membership and benefits.