Patience Makwele
The Namibia Health Plan (NHP) has admitted that healthcare providers experienced failed claims processing and delayed payments.
NHP said the disruptions followed the fund’s transition to a new managed care service system, which started on 1 April.
NHP said the process caused operational disruptions that did not meet the fund’s expected standards.
Last week, reports emerged that dentists under the Namibia Dental Association (NDA) stopped treating NHP members from 25 April because of delayed claim payments.
NHP principal officer Dantago Garosas said the transition forms part of a plan to strengthen the fund’s long-term sustainability and improve healthcare management.
“The transition was the hardest step and also the step that forces the fund to become more resilient, transparent and clinically focused,” she said.
Garosas said the changes are aimed at improving member benefits, healthcare management and accountability.
“NHP embarked on its transition on 01 April 2026, with its main objective being the responsibility to protect the fund’s long-term sustainability and strengthen care management capability. This decision was taken through governance processes and with the Fund’s long-term value and member outcomes in mind. We made this change to make sure the fund stays strong and can keep supporting members, while also improving how healthcare is managed and delivered. These long-term benefits include cost saving and accountable reporting,” she said.
The fund admitted that some claims were not processed during the transition period, creating pressure for healthcare providers and employer groups.
NHP said it has introduced corrective measures to stabilise operations and reduce the backlog of unpaid claims. The fund said the April claims backlog has now been cleared, and most members are again receiving claims processing within normal timelines.
The fund also said its electronic claims switching system is working again and communication channels for urgent concerns have been strengthened.
However, NHP acknowledged that some challenges remain with medical procedure pre-authorisations. It said dedicated teams are now handling hospital admissions and urgent medical cases.
NHP said meetings with members, healthcare providers and regulators are scheduled for 11 May 2026.
The fund urged members affected by cash payments to submit claims through its support channels.
NHP said emergency care access, reimbursement processes and benefit rules remain operational despite the transition.
“NHP acknowledges the significant frustration, inconvenience and uncertainty caused during this period and extends its sincere apology to all affected stakeholders,” the fund said.
The fund said corrective measures have been introduced under executive management oversight to restore services and rebuild confidence.
Statistics on the fund’s website show that NHP has more than 40 468 principal members and 83 048 beneficiaries.
Healthcare providers confirmed that the transition caused payment delays.
General practitioner Dr Nelson Makemba said the problems were linked to the system transition and that some issues had already been resolved.
“They are generally a good medical aid; the recent incidences emanated from the transition that is taking place; otherwise most of it has been resolved already. I’ve received three payments from them within the month of April. I am of the opinion they are still one of the best in the country,” Makemba said.
Obstetrician and gynaecologist Dr David Emvula said some doctors started requesting cash payments because remittances were delayed.
“For the month of April we didn’t get any remittances from NHP, that’s why some doctors opted for cash to keep afloat,” Emvula said.
