Who is eligible to join BPOMAS?
Membership of the Scheme is available to ALL Botswana Government employees, pensioners, those working on contracts (with a medical aid as a benefit), employees that used to be classified as industrial workers and their dependants (spouse and children).
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 department / ministry before submission to the Administrators for processing. The turnaround for applications is a week after receipt by the administrator. The form must be accompanied by the member’s ID/Passport (for foreigners) and copy of the payslip. For member adding their children, a copy of birth certificate is required, for members adding their spouse, a copy of marriage certificate and spouse ID are required.
Who can be covered?
The following persons may be registered as dependants: Your spouse (husband/wife) Your children (children are covered until the age of 21, and up to 25 if they are still students. Children who are students will be required to submit letter from school, to confirm their academic status every year in order to remain covered by the medical aid). For children that have finished school but are not yet employed, the parents can continue covering them under the Adult Child Dependent up to the age of 35years.
Can I cover my Parents and Children that are beyond 21 and unemployed?
Effective 1st April 2019, members on BPOMAS will have the opportunity to add their parents and parents in law through the Parents and Parents In Law Cover. For children that have finished school but not yet employed, the parents can continue covering them under the Adult Child Dependent up to the age of 35years. For both the Parents Cover and Adult Child Cover, The member will have to pay the monthly subscription 100%, without the government subsidy.
What happens to my membership when I retire?
Members that have been with the medical aid for at least 1 year before retirement have an opportunity to continue with their medical aid. The government will continue to pay 50% towards the monthly subscription and the member 50%. Members are required to notify the scheme 3 months before retirement of the intention to retire so that arrangements can be made on how to pay the monthly premium before the pension salary. Pensioner membership is for life.
What are the benefit of joining the scheme?
Your benefit entitlement will depend on the option you choose between the three benefit options that the scheme has, Standard Benefit Option, High Benefit Option or Premium Benefit Option. For members on High Benefit and Premium Benefit, 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%. For members on Standard Benefit Option, the scheme settles the medical bill 100%. 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. Members on High Benefit and Premium Benefit Options have a Dread Disease of P165 000 for members on High Benefit and P300,000 for members on Premium Benefit which 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.The Scheme also has other benefits that it offers to the members and their covered dependents at no extra cost, this benefits include; funeral benefit up to P12,5000, Premium waiver and a medical emergency evacuation service, of international standing; through Med Rescue International (MRI) Botswana.
Are there any waiting periods?
There are ONLY four applicable waiting periods, Maternity benefits - 9 months from registration date. Specialized Dentistry - 12 months from registration date. Pre-Existing Condition-24 Months from the 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 medical provider.
How much do I pay for the medical aid?
Contributions are based on your basic salary, the benefit option you have selected 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 to the Scheme’s Administrators.
How do I pay my monthly contributions?
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.
Are the contributions constant?
Generally, contributions are kept constant for a year at a time except when your salary changes or when you add a dependant. The Scheme may review contributions on an annual basis and adjustments may be influenced by inflation, benefit utilization, and general financial performance of the Scheme.
How do I qualify for a co-payment exemption?
When the members 10% co-payment total P1 000.00 within one financial, an exemption letter is generated and sent to your post. The exemption will be effective only for the reminder of the financial year.
If I paid for myself, how do I submit the claim?
Members may post or hand deliver signed claims, within three (3) months of date of service, to the Administrators. A statement signed by the member or dependant certifying the truth and correctness thereof shall accompany every claim submitted to the Scheme.
What does due by you mean?
“Due by you” refers to the co-payment that the member has to pay for the services that have been invoiced by a healthcare service provider. It is the 10% that the member would have paid at the doctor’s office or at the pharmacy when medication was dispensed.
What is a recognized tariff?
A recognized tariff is a health service fee that has been approved by the management committee. Different tariffs exist for different services e.g. consultation tariff, hospital tariff.
What do I do when I need an extra card?
Member wishing for a duplicate card can send a request to the administrator via post, email or fax requesting a duplicate. The cost of a duplicate card is P10.00.
What happens when I have exhausted my benefits?
When a member has exhausted (finished) their benefits, they can make a request to the scheme for more benefits through exgratia. The management committee will assess the member’s request.
Is there cash back?
No, there is no cash back reason being that BPOMAS uses a Community Based Pricing Model, where members buy into a risk pool. For member on High Benefit, earning over P8,000.+ with one dependent, their monthly contribution would be P488, should a need arise and a member need a P120,00 cover, the medical aid would pay, this is made possible because of the contribution of other members.
How can I contact you if I need more information?
Members can easily walk in our offices located at Gaborone or Francistown. Members can also reach the scheme via email: firstname.lastname@example.org or call our call centre at 3650555