The Scheme aims to establish a fund by contributions, donations or otherwise which will then be used to defray the healthcare costs of members and their beneficiaries.
2.Who Manages The Affairs Of The Scheme?
The Scheme is managed by a Committee of 10 ex-officio persons appointed from key departments and staff associations. The Scheme is administered by Associated Fund Administrators Botswana (Pty) Ltd (AFA).
3. Who Is Eligible To Participate?
Membership of the Scheme is available ALL Botswana Government employees and their beneficiaries.
4. How Do I Become A Member?
In order to gain membership you must fill in the prescribed application form. This form must be counter-signed by your employer before submission to the Administrators for processing. The turnaround for applications is a week after receipt by the administrator.
5.Who Can Be Covered As A Dependant?
The following persons may be registered as dependants:
- Your spouse (husband/wife)
- Your unemployed children (provided they are under the age of 21 unmarried and not in receipt of regular income)
The Management Committee may also, under special circumstances, consider applications presented in respect of other dependants under the following conditions:
- Children, from the ages 21 to 25 who are students
- Children, over 21 who are physically or mentally disabled and are unmarried
6. What Medical Services Does The Scheme Cover?
A wide variety of healthcare services are covered for the members benefit. Amongst them are medical, paramedical, home nursing, surgical, dental and optical services.
7. What Are The Benefits Of Joining The Scheme?
Your benefit entitlement will depend on the option you choose; Standard benefit option OR High benefit option. When you and any of your dependants fall sick, the Scheme will settle 90% of the medical expenses up to the specified limits: within the prescribed Rules. You have the responsibility of settling the remaining 10%.
- You get value for money, excellent service and health
- Your claims are settled twice a month
- The Scheme will pay suppliers directly if a valid membership card is produced before treatment.
- The Scheme provides funeral benefits
- The Scheme provides a medical emergency evacuation service, of international standing; through Med Rescue International (MRIB) Botswana.
The Scheme offers two (2) benefit options to choose from:
Standard Benefit Option
This option offers an overall annual limit ranging from P13 500 to P18 500 per family per annum, depending on the number of registered dependants per member.
High Benefit Option
This option offers a basic annual limit of P85 000 per family per annum. Members of this Option are also entitled to additional P100 000, which serves as Dread Disease cover. The Dread Disease entitlement applies to 10 specified conditions namely: Heart Attack, Coronary Heart Disease, Stroke, Cancer, Kidney Failure, Organ Transplant, Paraplegia, Blindness, Multiple Sclerosis and Motor Vehicle Road Traffic Accident.
8.Are There Any Waiting Periods Before Enjoyment Of Benefits?
There are ONLY three applicable waiting periods:
- Maternity benefits - 9 months from registration date
- Specialized Dentistry - 12 months from registration date
- Infants not registered within 30 days of birth - 3 months from registration date.
Note: The waiting periods do not apply to anyone who has been a registered member or dependant of a recognised medical aid Scheme for a continuous period of at least one (1) year and your application to join BPOMAS is made within three months of termination with your previous provider.
9.How Much Are My Contributions?
Contributions are based on your basic salary and the number of dependants covered under your membership. Once your application form has been assessed and approved, you are liable to pay half (by salary deduction) of the monthly contributions, while your employer pays the other half. The entire amount will then be remitted by your employer tom the Scheme’s Administrators.
Example: If your monthly contribution is assessed to be P300; your employer will deduct P150 from your monthly salary, assist you with the other P150 and send the total amount to the Administrators as payment for your medical aid cover.
10.How Do I Pay My Contributions?
Contributions are based on your basic salary and the number of people covered under your membership. Once assessed, you will pay a proportion (by salary deduction) of the amount while your employer contributes the rest. The entire amount will then be remitted by your employer to the Fund. For example, assuming that your contributions are assessed as P180, your employer may pay anywhere from 50% (P90) of this amount while you pay the balance (P90).
11.Are The Contributions A Constant Amount?
Generally, contributions are kept constant for a year at a time. Adjustments may be made from time to time; depending on the actual utilisation of benefits and the financial position of the Scheme. By being prudent members can positively influence the maintenance of low premiums. The higher the claims, the higher the contributions and vice versa.
12. How Can I Help To Keep Costs Down And Therefore Premiums Low?
The key thing to remember is that this is your Scheme; therefore, to keep your costs down you need to:
- Keep your body healthy through regular exercise. Discuss the cost and content of your treatment with your doctor (impressing the wish to receive the best care at the minimum cost available).
- Ensure that only those who are registered as your beneficiaries have the benefit of using your membership card when paying for services. This has the advantage of protecting your benefits against erosion, and keeping your monthly premiums low.
- Generally look after yourself well.
Surpluses are retained for future payment of benefits, while losses, if any, are made up by an increase in contributions.
14.How Do I Make A Claim?
Members may post or hand deliver signed claims, within four (4) months, to the Administrators. Every claim submitted to the scheme shall be accompanied by a statement signed by the member or dependant certifying the truth and correctness thereof.
15. Is The Card Well Recognized As A Means Of Payment?
Yes, close to 95% of health suppliers in Botswana will take the card as ready payment. Our guarantees also cover treatment obtained in South Africa.
16.Where Can I Obtain Further Information About The Scheme?
Personnel at Associated Fund Administrators Botswana (Pty) Ltd., (AFA), who are the Schemes administrators, will be happy to give you detailed information and answer any questions. You may come personally, call or contact them at the following addresses:
Botswana Public Officers'
Medical Aid Scheme AFA House, Plot 61918
Showgrounds Office Park , Gaborone , Botswana
P.O Box 1212 Gaborone , Botswana
Tel: (+267) 395 1166 / 365 0500 Fax: (+267) 395 1165 Email: marketing@afa.co.bw
