By Shania Lazarus
2 August 2025
The Namibia Private Practitioners Forum (NPPF) has accused the Namibian Association of Medical Aid Funds (Namaf) of implementing an outdated and unscientific tariff model that is costing medical aid fund members more money.
In a statement issued this week, NPPF chief executive Jürgen Hoffmann said the new tariff benchmarks directly disadvantage medical aid fund members by reducing the value of their medical cover and forcing them to pay larger co-payments.
“In practice, the benchmark tariff system shifts the cost burden onto fund members – while allowing medical aid funds to accumulate large surpluses,” said Hoffmann.
According to Hoffmann, by pegging benefit payouts to artificially low benchmarks, medical aid funds reduce the amount reimbursed to members for medical services while healthcare providers charge above those benchmarks due to rising costs.
The difference between what the medical aid fund will pay and what the healthcare charges is, therefore, forced on the medical aid member.
“Namaf’s outdated tariff model is not only unlawful in its implementation but undermines access to private healthcare, reduces the value of medical cover, and threatens the long-term sustainability of private practice in Namibia,” said Hoffmann.
He said Namaf is only acting in the best interest of medical aid funds as it is funded by them, however, these new tariffs control fund expenditure at the expense of healthcare providers, and fund beneficiaries.
Hoffmann further said Namaf’s tariff model is outdated and unscientific because the last independently verified costing model was developed over two decades ago in 2003.
“Inflation, medical technology, practice costs, and healthcare demand have all changed in the past 22 years, yet Namaf’s tariff updates remain opaque and based on internal calculations,” said Hoffmann.
He added that an independent cost study commissioned by the NPPF in 2014 found Namaf’s tariff setting methodology to be unscientific.
“Since then, Namaf hides the tariffs behind a digital wall, making independent scrutiny impossible, including that of patients,” said Hoffmann.
In the first quarter of 2025, Namibia’s medical aid funds recorded a combined surplus of N$229.7 million, while patients faced increased co-payments and doctors struggled to cover their overheads.
In response, Namaf spokesperson Uatavi Mbai clarified that benchmark tariffs are not mandatory or enforceable rates.
“Benchmark tariffs are not mandatory or enforceable rates. They are reference points, not prescribed ceilings or fixed prices. Each medical aid fund retains full autonomy to set its benefit levels in line with its financial model, product offerings, and member needs,” says Mbai.
Additionally, healthcare providers are not bound by the benchmark tariff, they may charge above or below it, based on their cost structures and professional discretion.
Regarding the reduction in the Additional Hospital Benefit, Mbai says that was an independent decision by individual medical aid funds.
“Namaf does not compel medical aid funds to adhere to any specific reimbursement percentage – each fund makes that determination based on actuarial advice, business strategy, and affordability considerations.”
Mbai adds that Namaf tariff calculations follow a structured and transparent process, incorporating relative value units and monetary conversion factors that reflect real-world inputs like salaries, equipment costs, and inflation.
Additionally these tariffs are updated annually, and Namaf invites submissions from healthcare providers whose costs have changed significantly.
Link to original article: https://www.namibian.com.na/namaf-accused-of-harmful-tariff-system/
