The Namibia Association of Medical Aid Funds (Namaf) has announced a 4.67% weighted average increase in benchmark tariffs for 2027, a move that could affect medical aid reimbursements and out-of-pocket healthcare costs for members.
According to Namaf, the adjustment, announced on 27 October 2026, follows a review of submissions from healthcare providers and professional associations as part of the annual Coding and Benchmark Tariff Review process.
The benchmark tariffs serve as reference rates used in Namibia’s private healthcare funding industry to guide payments for medical services.
The 4.67% increase means that, on average, the benchmark amounts for healthcare services will rise by 4.67% in 2027. For example, a medical procedure with a benchmark tariff of N$1,000 would increase to approximately N$1,046.70 if the full adjustment applied to that service.
However, the increase does not automatically mean that medical aid monthly contributions will rise by 4.67%, nor does it guarantee that medical aid funds will reimburse healthcare providers at the revised benchmark rates.
The actual financial impact on members will depend on individual medical aid fund rules, benefit structures, reimbursement arrangements and the fees charged by healthcare providers.
Namaf Stakeholder Relationship and Communication Manager Uatavi Mbai said the adjustment was intended to balance rising healthcare costs against the financial pressures facing medical aid members, employers and medical aid funds.
“The benchmark tariff review requires us to consider several realities at once: the cost of providing quality healthcare, the affordability of medical aid cover, the sustainability of medical aid funds and the broader economic environment in which our industry operates. The 4.67% weighted average increase reflects our considered approach to balancing these competing but interconnected priorities,” Mbai said.
According to Namaf, healthcare providers continue to face rising operating expenses, including staff remuneration, medical consumables, equipment, professional indemnity and other essential costs.
At the same time, medical aid members and employers are experiencing cost-of-living pressures that could affect their ability to maintain medical aid cover.
The association said medical aid funds must also remain financially sustainable while meeting their obligations to members and complying with regulatory requirements.
The 2027 review attracted a significant number of submissions from healthcare providers and professional associations following a stakeholder engagement campaign.
Namaf said the submissions were assessed against established criteria, including supporting cost data, clinical considerations and the potential financial implications for medical aid funds and their members.
The association stressed that benchmark tariffs should not be interpreted as fixed prices or guaranteed reimbursement amounts.
“A benchmark tariff serves as a reference point to promote consistency in the private healthcare funding industry. It is not a guarantee of reimbursement at a particular rate, nor does it replace the need for responsible engagement between the parties,” Namaf said.
This means healthcare providers may charge fees above the benchmark tariff, potentially leaving medical aid members responsible for paying the difference where their medical aid funds do not cover the full amount.
Similarly, medical aid funds may apply reimbursement rates based on their own rules and arrangements, meaning the revised benchmark tariffs will not necessarily translate into identical increases across all medical aid schemes.
Namaf has called on healthcare providers to maintain accurate billing and coding practices, while urging medical aid funds and administrators to ensure timely claims processing and protect members’ interests.
The association said it would continue working with industry stakeholders to improve the transparency of tariff reviews, strengthen the use of industry data and address fraud, waste and abuse within the private healthcare funding system.
The new benchmark tariffs are intended to apply in 2027, although Namaf’s announcement did not specify how individual medical aid funds would adjust their reimbursement rates or monthly contributions.
