By: Nghiinomenwa-vali Hangala
Namibia Health Plan Medical Aid service provider has acknowledged the issues regarding the processing of medical related payments to medical service providers as requested by members.
The company held an engagement with its members and healthcare services providers this week after it was reported to the regulator, Namfisa.
During the engagement, Namibia Health Plan (NHP) promised to take steps to address the challenges which arose over the past few weeks.
It stated that processing issues were due to the transition period to a new Managed Care Service Provider, which took effect on 01 April 2026.
NHP explained that the transition to a new Managed Care Service Provider is a step towards strengthening its managed care service provision.
The Fund emphasised that this transition is aimed at improving healthcare management, delivering better health outcomes for members and ensuring the long-term sustainability of the Fund and its stakeholders, including healthcare service providers.
During the session, the Fund addressed issues such as claims that have not been processed, acknowledging the administrative burden thereof for healthcare service providers and employer groups.
The Fund ensured its stakeholders of the updates and implementations put in place to resolve the issues.
Moreover, NHP also provided an update on the addressed concerns raised by the regulator on the transition implementation.
During the engagement, Dantago Garosas, NHP Principal Officer, explained that the members’ benefits have not changed.
“All existing benefits remain the same during this transition. There are no changes to cover or contributions. Fund Rules, benefit options, benefit limits, and member contributions remain unchanged,” she said.
“The disruptions experienced are administrative only,” Garosas emphasised.
She added that the challenges experienced do not relate to benefit reductions or amendments; members remain fully covered in line with their existing benefit option and Fund Rules.
Garosas further highlighted the journey of the transition to Universal Health Care.
Sabrina Jacobs, the Chairperson of the Namibia Health Plan Board of Trustees, assured members that they remain the top priority.
“We would like to assure you from the outset that the fund management and the service providers are actively working towards stability. We will continue to work with the managed care service provider to ensure that the coding alignment remains aligned to NAMAF”.
The fund has stated that it will continue to adhere to regulatory changes such as the Financial Institutions and Markets Act (FIMA), and will ensure compliance while transitioning towards the implementation of its new model.
erastus@thevillager.com.na
