WHAT WE ASK OF YOU

Sanlam Namibia One Stop Client Service Office, Sanlam Building,

 Settle account in full with service provider who does not have a
contract with PSEMAS and then submit 95% of the claim with all
Independence Avenue: Monday – Friday 9:00- 15:30
relevant information to PSEMAS. Telephone: 061- 294 7207; Fax: 061- 287 6091;
 Apply to Public Service Commission for Financial Assistance if unable e-mail: [email protected]
to settle account with above- mentioned service provider.
 Reconcile your remittance statement immediately to have able time to Government Office Park12 Luther Street (Across GRN Office Park):
resubmit any rejection claim. Monday- Friday:8:00 – 17:00
 Be honest, polite and give accurate documentation and information Telephone: 061- 374150; Fax: 061- 287 6091;
on time e-mail: [email protected]
 The members have the choice to apply for High or Standard option
 Standard option have limited amount on acute and chronic Luderitz MINISTRY OF FINANCE
medication, as well as the access to state hospital only unless service Luderitz Waterfront: Monday- Friday:9:30 – 17:00
not available in state hospital.
Telephone: 063- 203525; Fax: 061- 203561;
 With High option you have unlimited benefits with medication and
have access to private hospital with pre – authorization only.
e-mail: [email protected] CUSTOMER SERVICE CHARTER
ADMINISTRATORS BRANCHES Keetmanshoop
Ground Floor, Hendrik Nel Centre: Monday, Tuesday, Thursday, Friday
Oshakati 8:00 – 13:00 & 14:00- 17:00; Wednesday closed
Bank Windhoek Building: Monday, Tuesday, Thursday, Friday 9:30 – 17:00;
Wednesday 13:00- 17:00
Telephone: 063- 224908; Fax: 063- 224897;
e-mail: [email protected]
PUBLIC SERVICE
Telephone: 065- 220774; Fax: 065- 220779;
e-mail: [email protected] Rosh Pinah
MEDICAL AID SCHEME
Shop 3, Shoprite You Save Building, Ondye Drive: Monday- Friday:8:00
Tsumeb
Tsumeb Private Hospital: Monday – Friday 8:00 – 17:00 – 17:00
Telephone: 063- 274901; Fax: 063- 274902;
Ensure effective coordination and
Telephone:067- 221767; Fax:067- 222812;
e-mail: [email protected] e-mail: [email protected] management of the Public Service
Swakopmund DEALING WITH YOUR COMPLAINTS Employee Medical Aid Scheme
Bank Windhoek Building: Monday, Tuesday, Thursday, Friday 9:30 – 17:00;
Wednesday 13:00- 17:00
(PSEMAS) through the registration
When you are of the opinion that you are not being treated properly, you
Telephone:064- ; Fax:064- ; can request to see head of the station where the query arises, who will of members and coordinating of
e-mail:
assist you right away;
members services.
Walvis Bay
Cottage Hospital: Monday- Friday:8:00 – 17:00 The Permanent Secretary
Telephone :064-200563; Fax:064-200376; Ministry of finance
e-mail: [email protected]
Private Bag 13185
Windhoek Windhoek
Head Office, Methealth Office Park, Maerua Mall c/o Robert Mugabe& Jan Tel 061 209 2929
Jonker: Monday- Friday: 8:00 – 17:00
Telephone: 061- 294 6000; Fax: 061- 287 6091; Fax 061 230 179
e-mail: [email protected]
And if you are still not satisfied with the response from the Directorate
you may take the matter up with the Permanent Secretary. Should you
still not be satisfied with the response or action taken you can
approach the Minister of The Ministry of Finance. If not yet satisfied you
may approach the Office of the Ombudsman.
 Claims procedure
THIS CHARTER  Claims should be submitted to Administrators within 180 days (6 months) from
Membership Application procedures
Outlines: the date upon which member visited the service provider.
Membership of PSEMAS is voluntary
1. What we do  If new employee joins the fund within 90 days of assumption of duty Pay to Member Claims Procedure
2. Our Customers for High or Standard Option, there will be no waiting period to claim Claims are paid to members on a weekly basis and can either be electronically
3. Our commitment to you the benefits. transferred into the members bank account (please register for this facility at your
4. Our service promise/Standards  Member’s changes to other options can only be done within the next personnel office) or cheques are posted to members.
financial year.
5. When you contact us  Joining PSEMAS after 90 days after assumption of duty, there are Pay to Service Provider
6. What we ask of you  Service providers’ claim are paid on a weekly basis;
120 days waiting period to claim the benefit.
 Contracted-in service providers are paid within 30 days of receipt of the claim;
7. Dealing with your complain and
Registration of Dependants  Contracted-in service providers are paid directly 95% of the prescribe PSEMAS
 Employee must upon application of membership register all his/ her tariff.
WHAT WE DO dependants.
 Provide medical aid to, members and dependants of the public  Any changes in the number of dependants must be notified to Period of Validity of Claim
service employee’s medical aid scheme, PSEMAS. Personnel Office within 60 days of the change of events.  Members and service providers have a maximum period of 180 days (6 months)
 Pay 95% of agreed tariff and members pay 5% to service provider  Dependants can remain on medical aid up to 21 years and if older from the day of service to submit claim to PSEMAS.
 When member/ service provider was requested to re-submit correct claim, 180
of prescribe PSEMAS medical treatment. he/she qualify up to 25 years as dependants only if: full-time
days period will be calculated from the date of service and not from the date on
 Administration, e.g. registration of member, printing of cards, student; attending educational institution in full-time capacity; and which the Administrator of PSEMAS receives the resubmitted claim.
auditing doctors and payment of claim physically or mentally disabled.
 After decease of main members Hospitalisation
 Hospitalisation on PSEMAS is restricted to state hospitals only and claims are
OUR CUSTOMERS Suspension of Membership only paid based on state tariffs for Standard Option and all High option
 Public Servants, Offices, Ministries and Agencies, Regional  PSEMAS will be suspended when employee: members can have access to private hospitals with pre- auth.
Councils, GIPF, Old Mutual and Sanlam  is absent from duty for a period of 90 days; and  Hospital treatment outside the boarders of Namibia are covered due to no state
facilities available, but its subject to approval
 is a pensioner and a resident outside the border of Namibia
WE COMMIT TO YOU for period of 2 years WHEN YOU CONTACT US
 Encouraging and achieving the highest possible degree of
compliance with the PSEMAS specifications and conditions. Termination of Membership ENQUIRIES BY TELEPHONE
 Determining the extent of compliance and the cause of non-  On the day the service of employee is terminated;  Answer the telephone within 5 rings; if we are not in the office, the call will
 Immediately before the date he/she becomes a dependant of be forwarded to the switchboard or another staff member to take a
compliance and shall take action to correct the situation through message;
PSEMAS;
education.  Identify ourselves by name;
 Immediately before the date he/she becomes a dependant or a
 Transparency and publication of outcomes member of another medical aids scheme;  Inform you when you can expect a full reply, if cannot answer you enquiry
 Continuously searching for and implementing of new, more immediately.
 Immediately before the date he/she becomes a pensioner; and
efficient and effective ways of accomplishing our role.  Upon the date of his/her death. ENQUIRIES BY LETTER
 Reply to all letters within ten working days;
OUR SERVICE PROMISE/STANDARDS Membership contributions:  Inform you in writing when to expect a full reply;
 To register Members and respective dependants within 60days of High Option: Main member: N$240.00 per month  Treat faxes and e-mails as letter;
Dependent : N$120.00 per month  Always respond to your letters in writing.
receipt of application
 To print membership cards weekly and monthly Standard Option: Main member: N$ 120.00 per month PERSONAL VISITS TO OUR OFFICES
 To do members and doctor’s payments within 30 days. Dependent : N$ 60.00 per month  See you upon the agreed time if you have made an appointment;
 To allow members access to health facilities by negotiating with  Answer your questions immediately or inform you when to expect an
answer from us.
health professionals to contract in with PSEMAS Membership of Pensioners  Open door policy for any emergency registration within 20 min
 A pensioner must re- apply within 90 days from date of his
retirement to become a pensioner members of PSEMAS; HANDLING OF ENQUIRIES
 In case of a death of pensioner, the member spouse must apply to Visit or contact any of our ten branches nationwide for the following services:
become the main member within 90 days of the pensioner’s death.  Deviation matters
 Member needs to be a members for at least 2 years before  Assistance with understanding the claims process and payment
retirement  Fund related queries
 Dental quotations
 Receipt of claims
 Telephone queries