Access Health Services Covered on the scheme
The NHIMA Benefit Package is a list of medical services and procedures that the National Health Insurance Management Authority offers to its esteemed beneficiaries of the scheme. The scheme is a family cover but the benefits are per insured individual
Pharmaceuticals and Blood Products
It covers for the costs of medicines prescribed in generic names and medical consumables as per the National Essential Medicines List. It includes a medicine list recommended from time to time to meet members evolving needs. The benefit package provides for whole blood where indicated as part of the treatment protocol.
OPD Registration and Consultation
The benefit package covers for the costs of daily patient admission in private or ordinary ward ,Intensive Care Unit, High Dependent Unit, Services for the daily admission costs depending on the level of the facility and
the agreed daily rates as per the tariff schemes. Investigations, Nursing care, Oxygen therapy Medicines and Medical Consumables dispensed while the member is admitted.
Physiotherapy and Rehabilitation Services
The benefit package covers for cost of physiotherapy and rehabilitation services offered as in-patient and out-patient.
Lab Services and Radiology Services
The benefit package covers for Investigations and Diagnostic tests as per the Investigation List in the benefits Package.
This includes radiological investigation such as XRay, CT scan, MRI, Ultra sound and Mammogram
Dental and Oral Health Services
The benefit package covers for oral health services for both inpatient and outpatient. This includes dental conservation surgeries (e.g. dental filling), gum diseases, dental extractions, braces, dentures and root canal treatment.
Vision Care and Spectacles
The benefit package covers for visual corrective spectacles to the member once for every three years as well as vision care services for interventions for conditions such as Cataract, Glaucoma and trauma.
Maternal, New-born and Pediatric Services
The benefit package covers for cost of deliveries both normal and caesarean, obstetric and gynecological interventions, Newborn and pediatric services as listed in the package.
Surgical Services
The benefit package covers for the cost of minor, major, orthopaedic, ENT and diagnostic surgical procedures. The tariff for surgical procedures will include the cost for anaesthesia disposables; medicines and medical consumables, dressing, Orthopaedic implants and other medical expendables used during the operation.
More Services
01.
Medical / Orthopedic Appliances and Prosthesis
02.
Cancer / Oncology Services
03.
Physiotherapy and Rehabilitation Services
Download the benefit package by clicking the button below
A national health insurance scheme established for all Zambians and established citizens