What Is The Objective Of The Scheme?

The Scheme aims to establish a fund through contributions, donations or otherwise which will then be used to defray the healthcare costs of members and their dependants.

Who Manages The Affairs Of The Scheme?

The Scheme is managed by a Committee of 12 ex-officio persons appointed from key departments and staff associations/unions. The Scheme is administered by Associated Fund Administrators Botswana (Pty) Ltd (AFA).

Who Is Eligible To Participate?

Membership of the Scheme is available to ALL Botswana Government employees and their dependants.

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.

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 anyone of 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

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.

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% and,

  • 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.

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 medical provider.

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 to the Scheme’s Administrators.

How Do I Pay My 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 A Constant Amount?

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 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 and balance diet. Discuss the cost and content of your treatment with your doctor (impressing the wish to receive the best care at appropriate and affordable cost).
  • Ensure that only those who are registered as your dependants have the benefit of using your membership card when accessing services. This has the advantage of protecting your benefits against erosion, and keeping your monthly premiums low.
  • Generally look after yourself well.

How Are The Schemes Surpluses Utilised?

Surpluses are retained for future payment of benefits, while losses, if any, may be made up for by an increase in contributions.

How Do I Make A Claim?

Members may post or hand deliver signed claims, within four (4) months of date of service, 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.

Is The Card Well Recognized As A Means Of Payment?

Yes, close to 99% of service providers in Botswana will take the card as ready payment. Our guarantees also cover treatment obtained in major health facilities in South Africa.

Where Can I Obtain Further Information About The Scheme?

Personnel at Associated Fund Administrators Botswana (AFA) (Pty) Ltd, 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 BPOMAS addresses.