HIV/AIDS Programme


The management of the HIV and AIDS is based on the MyHealth HIV protocol, which is guided by the National ART guidelines of MOHSS.

MyHealth Objectives
1. Provide quality services to both clients and the service providers
2. Strengthen education and counselling services
3. Build and strengthen the partnership with the MOHSS and other relevant partners/stakeholders
4. Strengthen cost-effective service delivery model

Strategic Actions

(i) Clinical Level

→Authorised the ARVs medications based on both National ART guideline and MyHealth protocol
→Strengthen treatment literacy to improve compliance
→Reinforce structural and responsible claiming of the Anti-retoviral Treatments (ARTs)


Switching Codes
The Following switching codes are exclusive for claiming ARVs medications:
NMC - NAMCN
BANKMED - BANKN
PSEMAS - PSMH

Consultation tariffs
First HIV consultation: 97046 - when the client is diagnosed
Follow ups consultations: 97095

(ii) Counselling Level
→Through its well-structured counselling programme

MyHealth focuses on the improved adherence to the attainment of optimal viral suppression for all the clients.
(iii) Counselling approaches
→Person-to-person session
→Telephone contact

We are client-centric, efficient and based on the individualised model

PEP and Prep
→ Consult the National Guidelines for further information.
[Find forms under Resources on the side menu]

Prevention from Mother to Child (PMTCT)
→Consult the National Guidelines for further information.

Registration process

Why is it important to register

- Provide the consent to MyHealth to manage your health related issues
- Access the benefits attached to the MyHealth programme

How to register
- Complete the forms
- Dr will send the forms and relevant blood results to MyHealth
- Once forms are received, registration process will be completed within 8 hours

What does the benefits include
- 6 additional consultations
- Free levy on all authorised ARVs
- Free levy of baby Formula for the first 6 months

What education do you get
- How to take medications properly
- How to possibly manage side effects
- How to prevent HIV re-infection
- Overall health education

Programme registration forms
- ARVs are subjected to case management - required to be authorised prior being administered.
- Thus all the newly HIV-diagnosed clients should go through the registration process.
- The registration forms and the baseline blood results are eminent to complete the registration process. The client must sign the Part A of the forms to give his/her consent


TOP HIV Drugs



BANKMED

No. Drug Name
1TEEVIR
1TLD1
2ANZAVIR
2Kocitaf
3ADCO-EMTEVIR
4ADCO-EFAVIRENZ
5RICOVIR
6ALUVIA
7AVONZA
8TIVICAY
9COMBIVIR
10TREZAV (NAMIBIA ONLY)
11ADCO-ZIDOVUDINE
12TRIUMEQ
13DIDIVIR
14KIVEXA
15ADCO-LAMIVUDINE & ZIDOVUDINE

NMC

No. Drug Name
1TEEVIR
2ADCO-EFAVIRENZ
3AVONZA
4ADCO-EMTEVIR
5ALUVIA
6ZOVILAM
7RICOVIR-EM
8ANZAVIR-R
9TREZAV (NAMIBIA ONLY)
10ADCO-LAMIVUDINE & ZIDOVUDINE
11TIVICAY
12ALUVIA
13COMBIVIR
14ADCO-ZIDOVUDINE
15CIPLA-EFAVIRENZ

PSEMAS

No. Drug Name
1TEEVIR
2ZOVILAM
3ALUVIA
4RICOVIR-EM
5ADCO-EFAVIRENZ
6ANZAVIR-R
7TREZAV
8ADCO-EMTEVIR
9CIPLA-EFAVIRENZ
10AVONZA
11TIVICAY
12TRUSTIVA (NAMIBIA ONLY)
13ADCO-LAMIVUDINE
14TELURA (NAMIBIA ONLY)
15ASPEN NEVIRAPINE


HIV/AIDS BENEFITS


BANKMED

BANKMED ESSENCE (2020)

BENEFITS
24. Specified Illness Conditions (Subject to pre-authorisation)Limited to N$33 250 per Beneficiary
24.1 HIV/AIDS (As per National Guidelines for Antiretroviral Therapy)
24.1.1 Medicine Paid at Maximum Namibia Medicine Price List on Generics100%Sub-Limit 24
24.1.2 First Full HIV Consultation/AssessmentN$440Once-off benefit
Sub-limit 24
24.1.3 Consultation (after the first full HIV Consultation/ Assessment)N$405Limited to 6 consultations per Beneficiary Sub-limit 24
24.1.4 HIV Counselling100%Limited to N$1 300 per Beneficiary Sub-limit 24
24.1.5 Pathology Tests100%Sub-limit 24
24.1.6 HIV Resistance Test (Subject to prior approval)100%Sub-limit 24
As per National Guidelines
24.2 Prevention of Mother-to-Child Transmission (PMCTC)100%Sub-limit 24
As per National Guidelines
24.3 Post-Exposure Prophylaxis (PEP)100%Sub-limit 24
As per National Guidelines
24.4 Pre-Exposure Prophylaxis (PrEP)100%Sub-limit 24
As per National Guidelines

BANKMED PRIME (2020)

BENEFITS
24. Specified Illness Conditions (Subject to pre-authorisation)Limited to N$33 250 per Beneficiary
24.1 HIV/AIDS (As per National Guidelines for Antiretroviral Therapy)
24.1.1 Medicine Paid at Maximum Namibia Medicine Price List on Generics 100%Sub-Limit 24
24.1.2 First Full HIV Consultation/AssessmentN$440Once-off benefit
Sub-limit 24
24.1.3 Consultation (after the first full HIV Consultation/ Assessment)N$405Limited to 6 consultations per Beneficiary Sub-limit 24
24.1.4 HIV Counselling100%Limited to N$1 300 per Beneficiary Sub-limit 24
24.1.5 Pathology Tests100%Sub-limit 24
24.1.6 HIV Resistance Test (Subject to prior approval)100%Sub-limit 24
As per National Guidelines
24.3 Post-Exposure Prophylaxis (PEP)100%Sub-limit 24
As per National Guidelines
24.4 Pre-Exposure Prophylaxis (PrEP)100%Sub-limit 24
As per National Guidelines

BANKMED CARE (2020)

BENEFITS
21. Specified Illness Conditions (Subject to pre-authorisation)Limited to N$33 250 per Beneficiary Overall Annual Limit
21.1 HIV/AIDS (As per National Guidelines for Antiretroviral Therapy)
21.1.1 Medicine Paid at Maximum Namibia Medicine Price List on Generics100%Sub-limit 21
21.1.2 First Full HIV Consultation/AssessmentN$440Once-off benefit
Sub-limit 21
21.1.3 Consultation (after the first full HIV Consultation/ Assessment)N$405Limited to 6 consultations per Beneficiary
Sub-limit 21
21.1.4 HIV Counselling100%Limited to N$1 100 per Beneficiary
Sub-limit 21
21.1.5 Pathology Tests100%Sub-limit 21
21.1.6 HIV Resistance Test (Subject to prior approval)100%Sub-limit 21
21.2 Prevention of Mother-to-Child Transmission (PMTCT)100%Sub-limit
21 As per National Guidelines
21.3 Post-Exposure Prophylaxis (PEP)100%Sub-limit
21 As per National Guidelines
21.4 Pre-Exposure Prophylaxis (PrEP)100%Sub-limit
21 As per National Guidelines

BANKMED HOSPITAL (2020)

BENEFITS
21. Specified Illness Conditions (Subject to pre-authorisation)Limited to N$33 250 per Beneficiary Overall Annual Limit
21.1 HIV/AIDS (As per National Guidelines for Antiretroviral Therapy)
21.1.1 Medicine Paid at Maximum Namibia Medicine Price List on Generics100%Sub-limit 21
21.1.2 First Full HIV Consultation/AssessmentN$440Once-off benefit
Sub-limit 21
21.1.3 Consultation (after the first full HIV Consultation/ Assessment)N$405Limited to 6 consultations per Beneficiary
Sub-limit 21
21.1.4 HIV Counselling100%Limited to N$1 300 per Beneficiary
Sub-limit 21
21.1.5 Pathology Tests100%Sub-limit 21
21.1.6 HIV Resistance Test (Subject to prior approval)100%Sub-limit 21
21.2 Prevention of Mother-to-Child Transmission (PMTCT)100%Sub-limit
21 As per National Guidelines
21.3 Post-Exposure Prophylaxis (PEP)100%Sub-limit
21 As per National Guidelines
21.4 Pre-Exposure Prophylaxis (PrEP)100%Sub-limit
21 As per National Guidelines



NMC

NMC TOPAZ (2020)

BENEFITS
Category B: HIV/AIDS Treatment% TariffsUnlimited According to Defined Protocols
Benefits only available at Network Health Professionals
12. HIV/AIDS TreatmentAs per National Guidelines for Antiretroviral Therapy
12.1 Consultations (General Practitioners)100%Unlimited
12.2 Medication (including vitamins & supplements)100%Unlimited
(According to Topaz and Topaz Plus HIV Medicine Formulary)
(Vitamins and supplements maximum of N$100)
12.3 Pathology100%Unlimited
12.4 Counselling (pre-, post & adherence)100%3 Sessions
12.5 Post Exposure Prophylaxis (PEP) (Rape Cover only)100%As per National Guidelines for Antiretroviral Therapy
12.6 Pre-Exposure Prophylaxis (PreP)No Benefit
12.7 Prevention of Mother-to-Child Transmission (PMTCT) (excluding milk formula)100%As per National Guidelines for Antiretroviral Therapy

NMC TOPAZ PLUS (2020)

BENEFITS
Category B: HIV/AIDS Treatment% TariffsUnlimited According to Defined Protocols
Benefits only available at Network Health Professionals
12. HIV/AIDS Treatment As per National Guidelines for Antiretroviral Therapy
12.1 Consultations (General Practitioners)100%Unlimited
12.2 Medication (including vitamins & supplements)100%Unlimited
12.3 Pathology100%Unlimited
(According to Topaz and Topaz Plus HIV Medicine Formulary)
(Vitamins and supplements maximum of N$100)
12.4 Counselling (pre-, post & adherence)100%3 Sessions
12.5 Post Exposure Prophylaxis (PEP) (Rape Cover only)100%As per National Guidelines for Antiretroviral Therapy
12.6 Pre-Exposure Prophylaxis (PrEP)No Benefit
12.7 Prevention of Mother-to-Child Transmission (PMTCT) (exluding milk formula)100%As per National Guidelines for Antiretroviral Therapy

NMC OPAL (2020)

BENEFITS
19. Specified Illness ConditionsLimited to N$41 000 per Family
Sub-limits are pro-rated from date of joining.
Overall Annual Limit
19.1. HIV/AIDS (As per National Guidelines for Antiretroviral TherapyLimited to N$24 150 per Beneficiary
19.1.1. Medicine Paid at Maximum Namibia Medicine Price List on Generics100%Sub-limit 19.1
19.1.2. First Full HIV Consultation/AssessmentN$460Once off benefit
Sub-limit 19.1
19.1.3. Consultation (after the first full HIV Consultation/Assessment)N$420Limited to 6 consultations per Beneficiary
Sub-limit 19.1
19.1.4. HIV Counselling100%Limited to N$1 250 per Beneficiary
Sub-limit 19.1
19.1.5. Pathology Tests100%Limited to N$5 450 per Beneficiary
Sub-limit 19.1
19.1.6. HIV Resistance Test (Subject to prior approval)100%Sub-limit 19.1
19.2. Prevention of Mother-to-Child Transmission (PMTCT)100%Sub-limit 19.1
As per National Guidelines
19.3. Post-Exposure Prophylaxis (PEP)100%Sub-limit 19.1
As per National Guidelines
19.4. Pre-Exposure Prophylaxis (PrEP)100%Sub-limit 19.1
As per National Guidelines

NMC JADE (2020)

BENEFITS
19. Specified Illness ConditionsLimited to N$41 000 per Family
Sub-limits are pro-rated from date of joining.
Overall Annual Limit
19.1. HIV/AIDS (As per National Guidelines for Antiretroviral TherapyLimited to N$24 150 per Beneficiary
19.1.1. Medicine Paid at Maximum Namibia Medicine Price List on Generics100%Sub-limit 19.1
19.1.2. First Full HIV Consultation/AssessmentN$460Once off benefit
Sub-limit 19.1
19.1.3. Consultation (after the first full HIV Consultation/Assessment)N$420Limited to 6 consultations per Beneficiary
Sub-limit 19.1
19.1.4. HIV Counselling100%Limited to N$1 250 per Beneficiary
Sub-limit 19.1
19.1.5. Pathology Tests100%Limited to N$5 450 per Beneficiary
Sub-limit 19.1
19.1.6. HIV Resistance Test (Subject to prior approval)100%Sub-limit 19.1
19.2. Prevention of Mother-to-Child Transmission (PMTCT)100%Sub-limit 19.1
As per National Guidelines
19.3. Post-Exposure Prophylaxis (PEP)100%Sub-limit 19.1
As per National Guidelines
19.4. Pre-Exposure Prophylaxis (PrEP)100%Sub-limit 19.1
As per National Guidelines

NMC RUBY (2020)

BENEFITS
32. Specified Illness ConditionsN$30 000 | N$43 000 | N$43 000 | N$43 000 | N$43 000 | N$43 000
32.1. HIV/AIDS (As per National Guidelines for Antiretroviral Therapy)Limited to N$30 000 per Beneficiary
32.1.1. Medicine Paid at Maximum Namibia Medicine Price List on Generics100%Sub-limit 32.1
32.1.2. First Full HIV Consultation/AssessmentN$460Once off benefit
Sub-limit 32.1
32.1.3. Consultation (after the first full HIV Consultation/Assessment)N$420Limited to 6 consultations per Beneficiary
Sub-limit 32.1
32.1.4. HIV Counselling100%Limited to N$1 250 per Beneficiary
Sub-limit 32.1
32.1.5. Pathology Tests100%Limited to N$5 720 per Beneficiary
Sub-limit 32.1
32.1.6. HIV Resistance Test (Subject to prior approval)100%Sub-limit 32.1
32.2. Prevention of Mother-to-Child Transmission (PMTCT)100%Sub-limit 32.1
As per National Guidelines
32.3. Post-Exposure Prophylaxis (PEP) 100%Sub-limit 32.1
As per National Guidelines
32.4. Pre-Exposure Prophylaxis (PrEP) 100%Sub-limit 32.1
As per National Guidelines

NMC SAPPHIRE (2020)

BENEFITS
32. Specified Illness ConditionsN$34 750 | N$69 500 | N$69 500 | N$69 500 | N$69 500 | N$69 500
32.1. HIV/AIDS (As per National Guidelines for Antiretroviral Therapy)Limited to N$34 750 per Beneficiary
32.1.1. Medicine Paid at Maximum Namibia Medicine Price List on Generics100%Sub-limit 32.1
32.1.2. First Full HIV Consultation/AssessmentN$460Once off benefit
Sub-limit 32.1
32.1.3. Consultation (after the first full HIV Consultation/Assessment)N$420Limited to 6 consultations per Beneficiary
Sub-limit 32.1
32.1.4. HIV Counselling100%Limited to N$1 250 per Beneficiary
Sub-limit 32.1
32.1.5. Pathology Tests100%Limited to N$7 500 per Beneficiary
Sub-limit 32.1
32.1.6. HIV Resistance Test (Subject to prior approval)100%Sub-limit 32.1
32.2. Prevention of Mother-to-Child Transmission (PMTCT)100%Sub-limit 32.1
As per National Guidelines
32.3. Post-Exposure Prophylaxis (PEP) 100%Sub-limit 32.1
As per National Guidelines
32.4. Pre-Exposure Prophylaxis (PrEP) 100%Sub-limit 32.1
As per National Guidelines

NMC EMERALD PLUS (2020)

BENEFITS
CATEGORY B:
Day-to-Day Backup Benefit
100% TariffLimited to:
N$6 000 Member only
N$10 200 Member + Adult
N$7 200 Member + Child
N$11 400 Member + Adult + Child
Additional N$1 200 benefit for each additional Child
OVERALL ANNUAL LIMIT
Benefits are pro-rated from date of joining
Ex-Gratia not Applicable
29. Specified Illness Conditions100%Paid from Day to Day Backup Benefit
Paid at Maximum Namibia Medicine Price List on generics
29.1 HIV/AIDS (As per National Guidelines on Antiretroviral Therapy)100%Paid from Day to Day Backup Benefit
29.1.1 Medicine100%Paid from Day to Day Backup Benefit
29.1.2 First Full HIV Consultation / Assessment100%Paid from Day to Day Backup Benefit
29.1.3 Consulation (after first full HIV Consultation / Assessment)100%Paid from Day to Day Backup Benefit
29.1.4 HIV Counselling100%Paid from Day to Day Backup Benefit
29.1.5 Pathology Tests100%Paid from Day to Day Backup Benefit
29.1.6 HIV Resistance Test (Subject to prior approval)100%Paid from Day to Day Backup Benefit
29.2 Prevention of Mother-to-Child Transmission (PMTCT)100%Paid from Day to Day Backup Benefit
29.3 Post-Exposure Prophylaxis (PEP)100%Paid from Day to Day Backup Benefit
29.4 Pre-Exposure Prophylaxis (PrEP)100%Paid from Day to Day Backup Benefit

NMC AMBER PLUS (2020)

BENEFITS
CATEGORY B:
Day-to-Day Backup Benefit
100% TariffLimited to:
N$9 000 Member only
N$15 000 Member + Adult
N$11 400 Member + Child
N$17 400 Member + Adult + Child
Additional N$2 400 benefit for each additional Child
OVERALL ANNUAL LIMIT
Benefits are pro-rated from date of joining
Ex-Gratia not Applicable
29. Specified Illness Conditions100%Paid from Day to Day Backup Benefit
Paid at Maximum Namibia Medicine Price List on generics
29.1 HIV/AIDS (As per National Guidelines on Antiretroviral Therapy)100%Paid from Day to Day Backup Benefit
29.1.1 Medicine100%Paid from Day to Day Backup Benefit
29.1.2 First Full HIV Consultation / Assessment100%Paid from Day to Day Backup Benefit
29.1.3 Consulation (after first full HIV Consultation / Assessment)100%Paid from Day to Day Backup Benefit
29.1.4 HIV Counselling100%Paid from Day to Day Backup Benefit
29.1.5 Pathology Tests100%Paid from Day to Day Backup Benefit
29.1.6 HIV Resistance Test (Subject to prior approval)100%Paid from Day to Day Backup Benefit
29.2 Prevention of Mother-to-Child Transmission (PMTCT)100%Paid from Day to Day Backup Benefit
29.3 Post-Exposure Prophylaxis (PEP)100%Paid from Day to Day Backup Benefit
29.4 Pre-Exposure Prophylaxis (PrEP)100%Paid from Day to Day Backup Benefit



PSEMAS

PSEMAS STANDARD OPTION (2018)

BENEFITS
14. HIV/AIDSSubject to registration on HIV and AIDS Disease Clinical Programme
14.1 HIV/AIDS Medicine100%N$25 000 per Beneficiary
Sub-limit 14
Generic reference pricing applicable
14.2 First Full HIV/AIDS Consultation/ Assessment 100%Sub-limit 14
1 1/2x Tariff for 0101 Consultation (Once off benefit)
In-house code to be used for claiming = 97046
14.3 HIV/AIDS Follow-up Consultation 100%Sub-limit 14
6 follow up consultations per beneficiary
In-house code to be used for claiming = 97095
14.4 HIV/AIDS Pathology Tests100%Sub-limit 14
14.5 Too Early to Treat100%Sub-limit 14
14.6 Post Exposure Prophylaxis100%Sub-limit 14
14.7 Pre Exposure Prophylaxis (PrEP)100%Sub-limit 14
14.8 Mother to Child Transmission100%Sub-limit 14

PSEMAS HIGHER OPTION (2018)

BENEFITS
14. HIV/AIDSSubject to registration on HIV and AIDS Disease Clinical Programme
14.1 HIV/AIDS Medicine100%N$25 000 per Beneficiary
Sub-limit 14
Generic reference pricing applicable
14.2 First Full HIV/AIDS Consultation/ Assessment 100%Sub-limit 14
1 1/2x Tariff for 0101 Consultation (Once off benefit)
In-house code to be used for claiming = 97046
14.3 HIV/AIDS Follow-up Consultation 100%Sub-limit 14
6 follow up consultations per beneficiary
In-house code to be used for claiming = 97095
14.4 HIV/AIDS Pathology Tests100%Sub-limit 14
14.5 Too Early to Treat100%Sub-limit 14
14.6 Post Exposure Prophylaxis100%Sub-limit 14
14.7 Pre Exposure Prophylaxis (PrEP)100%Sub-limit 14
14.8 Mother to Child Transmission100%Sub-limit 14