THE HAPPY AND HEALTHY PLANS - BENEFIT GUIDE 2021 AS - Bomaid
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THE HAPPY AND
HEALTHY PLANS
AS A B C
BENEFIT GUIDE 2021
THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
2
THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
CONTENTS
4 Plans Summary
6 2021 Benefit Schedule
13 10 Reasons To Join Bomaid
14 2021 New Benefits
16 Value Added Benefits
17 Dread Disease Cover
18 Severe Illness Benefit
19 Travel Insurance
19 Happy Student Plan
20 Managed Care Program
21 Chronic Ailment Program
22 Wellness Benefit
23 Screening Labs
24 Member Benefits
25 Personal Accident Disability
25 Premium Waiver
26 Bombaby
27 Additional Notes
28 2021 Subscriptions
30 Frequentl y Asked Questions
31 Our Self-Service Channels
3
THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
PLANS
SUMMARY
When it comes to the health & happiness of
your loved ones its good to have options.
AS HAPPY
If you’re looking for a low cost , hassle free, no co-payment health plan, then this
entry level plan is right for you. Offering you great Out of Hospital benefits, this plan
is ideal if you’re young, healthy and looking to acquire basic cover.
PLAN AS HAPPY BENEFITS:
• Outpatient Benefits • Screening & Prevention Benefit
• Managed Care Benefits • Covid-19 Care Benefit
• Dental & Optical Benefits • Appliances Benefit
• Maternity Care Program • Funeral Cover
A HAPPY
This plan is ideal for young, healthy individuals & start-up families. It provides
affordable cover that aims to free members from the worry of unexpected
mishaps by covering a wide range of benefits that most families encounter.
PLAN A HAPPY BENEFITS:
• Inpatient & Outpatient Benefits • Covid-19 Care Benefit
• Managed Care Benefits • Appliances Benefit
• Dental & Optical Benefits • Funeral Cover
• Maternity Care Program • Wellness Benefit
• Screening & Prevention Benefit
4
THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
B HAPPY
This mid-level plan gets an upgrade that includes the newly introduced Travel
Insurance cover. Getting this plan gives you and your family peace of mind as it
provides a broad dashboard of benefits to ensure total health and happiness.
PLAN B HAPPY BENEFITS:
• Inpatient & Outpatient Benefits • Covid-19 Care Benefit
• Managed Care Benefits • P2 million Travel Insurance Cover
• Dental & Optical Benefits • Funeral Benefit
• Maternity Care Program • Wellness benefit
• Screening & Prevention Benefit • Allied Health Services
C HAPPY
This upgraded top tier plan leaves nothing to chance. It gives you and your loved
ones elite cover & superior customer service by a dedicated relationship manager.
PLAN C HAPPY BENEFITS:
• Inpatient & Outpatient Benefits • P5 million Travel Insurance Cover
• Managed Care Benefits • Executive Annual Medical
• Dental & Optical Benefits Examination
• Maternity Care Program • Funeral Benefit
• Screening & Prevention Benefit • Applied Health Services
• Covid-19 Care Benefit • Wellness Benefit
5
THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
2021 BENEFIT
SCHEDULE
6
THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
2021 BENEFIT SCHEDULE (CONTINUED)
A S HAPPY A HAPPY B HAPPY C HAPPY
Single Family Single Family Single Family Single Family
OVERALL HEALTH
PLAN BENEFIT 37,790 44,568 274,145 290,772 866,532 1,009,686 1,351,121 1,785,000
LIMIT
IN-PATIENT
AND MANAGED
1 236,250 252,000 813,225 931,350 1,249,500 1,485,750
CARE BENEFITS B E N E F I T
OVERALL LIMIT
Dread Disease
Cover * - strictly
in accordance with
1.1 236,250 252,000 813,225 931,350 1,351,121 1,785,000
the Bomaid list of
approved dread
diseases
Hospitalisation
Cover Includes:
N O
• Neonatal
hospitalisations
• Doctors & other
Professionals Up to Up to Up to Up to Up to Up to
1.2
• Pathology 89,250 105,000 393,225 511,350 1,249,500 1,485,750
• Radiology
• Physiotherapy
• Chemo/Radio/
B E N E F I T
Brachytherapy
• Renal Dialysis
Mental Health
hospitalisation
(includes Alcohol &
1.2.1.1 15,750 15,750 42,000 52,500 53,000 70,000
Drug rehabilitation
) includes
Professional fees
Sub-acute care /
N O
nursing home
& home-based
1.2.1.2 15,000 28,000 43,000
care* (alternative
to hospital -
maximum 30 days)
B E N E F I T
In-patient Dental
Overall
Cover includes:
No Up to Up to Up to Up to
1.2.1.3 No benefit
benefit 51,600 103,200 65,000 130,000
• Hospital fees
• Dentist Fees
• Anaesthetist fees
Simple maxillo-
facial Up to Up to Up to Up to
14,000 20,000
surgery: acute or 51,600 103,200 65,000 130,000
N O
chronic *
Internal/External
1.2.2 10,000 15,000 60,000 80,000 80,000 100,000
Prosthesis
Normal delivery
hospitalisation fees
1.2.3 (include forceps 3,675 3,675 9,450 9,450 9,450 9,450
delivery and
vacuum extraction)
Caesarian
1.2.3.1 section delivery 6,825 6,825 13,650 13,650 14,700 14,700
hospitalisation fees
Birthing unit
delivery global fee
1.2.3.2 788 788 2,100 2,100 2,100 2,100
(by a registered
unit/facility)
7
THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
2021 BENEFIT SCHEDULE (CONTINUED)
A S HAPPY A HAPPY B HAPPY C HAPPY
Single Family Single Family Single Family Single Family
Chronic
medications *
(supplied through
the Managed
Care Program
in accordance
1.2.3.3 with the Bomaid 10,500 12,600 10,500 12,600 37,800 44,100 50,400 67,200
list of approved
chronic conditions)
Registration
through Bomaid
Managed Care
Program required
Extended chronic
medication benefit
1.2.3.5 5,250 6,300 18,900 22,050 25,200 33,600
* ^ (cover on
assessment)
ARV medications
per beneficiary *
(supplied through
the Managed
Care Program) 12,600
1.2.3.6 12,600 12,600 12,600
Registration with
the Bomaid
*Managed Care
Program Required
Laser refractive eye
surgery * (referrals
from approved
Ophthalmologist/
Optometrist) per
beneficiary per
no no
1.2.3.7 annum 2,646 3,528 4,725 5,775 5,775 6,825
benefit benefit
^ Guaranteed
Cover on
assessment
*Pre-authorisation
required
MEDICAL/
SURGICAL
OUT-PATIENT
OVERALL LIMIT
2 16,790 23,568 27,000 34,000 58,000 65,000 65,000 90,000
(Consultations,
Medications,
Investigations and
Procedures)
Registration with
2.1 the Bombaby 4 visits 4 visits 4 visits 4 visits
Program required
Drugs/Prescribed
2.2 3,491 4,935 3,950 5,400 7300 11600 15000 19200
Medicine Limit
Self medication
2.2.1 (prescribed by 105 210 200 400 300 600 500 700
pharmacist)
Doctor dispensed
2.2.2 medicine (for acute 525 788 750 1,000 1000 2,000 2,500 3,500
cases only)
Pharmacy
dispensed medicine
(includes dental
2.2.3 2,625 3,938 3,000 4,000 6,000 9,000 12,000 15,000
and ophthalmic
prescribed
medications)
8
THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
2021 BENEFIT SCHEDULE (CONTINUED)
A S HAPPY A HAPPY B HAPPY C HAPPY
Single Family Single Family Single Family Single Family
ARV medications
per beneficiary
(subject to
2.2.4 6,300 6,300 6,300 6,300
eligibility criteria,
refer to Notes on
Page 21)
2.2.5 Chronic Medication 12,600
Diagnostic/
Investigative
Procedure Cover
includes:
• X-Ray/
Ultrasound
scans
(excludes
3 obstetric
2.3 11,399 12,154 18,000 22,000 21,000 35,000 35,000 45,000
ultrasound
scans for
normal
pregnancy),
• Obstetric
ultrasound
scans
• MRI/CT
scans *
Laboratory
investigations/
2.3.1 1,139 1,657
tests excluding HIV
monitoring
HIV laboratory
monitoring per
beneficiary (subject
2.3.2 3,500 3,500 3,500 3,500
to eligibility
criteria, refer to
Notes on Page 21)
HIV laboratory
2.3.2.1 monitoring per 1,750 1,750 1,750 1,750
beneficiary
Infertility
diagnostic
2.3.3 procedures (limited no benefit no benefit no benefit no benefit 8,000 11,000
to Outpatient
Investigations).
Medical/Surgical
Procedure Cover
includes:
• Minor medical
procedures
2.4 • Minor surgical 4,673 6,694 5,000 7,000 9,000 12,000 12,000 18,000
procedures
• Major
procedures
(ambulatory)
* Pre-authorisation required ^ Cover on assessment
DENTAL AND
3 ORAL BENEFIT 2,268 3,187 14,500 20,500 35,000 50,000 45,000 55,000
OVERALL LIMIT
9
THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
2021 BENEFIT SCHEDULE (CONTINUED)
A S HAPPY A HAPPY B HAPPY C HAPPY
Single Family Single Family Single Family Single Family
Out-patient Dental
Overall Cover
Includes:
• Basic dentist-
ry (includes
consultations,
radiolo-
gy, filling,
extraction,-
cleaning,
scaling and
polishing,in- Up to Up to Up to Up to Up to Up to Up to Up to
3.1
cision and 2,268 3,187 14,500 20,500 35,000 50,000 45,000 55,000
drainage,root
canal treat-
ment
• Specialised
dentistry
*(includes
crowns,
bridges and
dentures) and
oral surgery
Orthondontic
treatment for
members up to 35
3.1.3 years of age * ˜ Up to 2,268 Up to 3,187 10,500 15,750 23,000 37,000 35,000 48,000
(braces, retainers
and related appli-
ances)
* Pre-authorisation required - Treatment every 2 years ˜ Refers to treatment once in a lifetime
OPTICAL
BENEFIT (2 year
benefit cycle per
beneficiary )
• Clear aquity
single vision
210
lenses (per
lens)
• Clear aquity
bifocal lenses 555
(per lens)
• Clear aquity
multifocal
705 UP TO UP TO UP TO
4 lenses (per
lens) 3,000 4,300 5,500
• Frame and/
or any lens 705
enhancements
• Contact
lenses (only
claimable as
an alternative
to frame
1,200
and lenses
per annum
subject
to benefit
availabilty)
10THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
2021 BENEFIT SCHEDULE (CONTINUED)
A S HAPPY A HAPPY B HAPPY C HAPPY
Single Family Single Family Single Family Single Family
APPLIANCES
5,250 6,195 7,000 15,000 15,000 20,000 21,000 26,000
OVERALL LIMIT
COVER INCLUDES:
• General
appliances
• Medical
appliances
• Surgical
appliances
• Wheel chairs,
crutches
and walking
frames (for
permanent
disability)
• Hearing aid
(prescription
5 required)
(maximum Up to Up to Up to Up to Up to
1,025 Up to 7,000
1 pair of 15,000 15,000 20,000 21,000 26,000
appliances per
2 year cycle)
• CPAP
machines,
home oxygen,
stoma
products
(CPAP
machines and
home oxygen
cover subject
to pre-
authorisation
and health
plan
protocols)
ALLIED HEALTH
2,909 4,541 3,000 5,000 8,000 13,000 12,000 18,000
SERVICE COVER
INCLUDES:
• Rehabilitation
Therapy
• Podiatry
6 • Occupational
therapy Up to Up to Up to
• Speech 1,061 1,680 Up to 3,000 Up to 5,000 Up to 8,000
13,000 12,000 18,000
therapy
• Clinical
psychology
• Clinical
dietetics
Alternative
Treatment
Cover Includes:
• Homeopathic
treatment
• Chiropractic
treatment
• Naturopathic
6.2 treatment
788 1,181 Up to 1,500 Up to 2,500 Up to 1,500 Up to 2,500 Up to 1,500 Up to 2,500
• Acupuncture
treatment
• Biokinetics
• Traditional
healing (cover
strictly limited
to Ngope,
Thobega and
Mototwane)
11THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
2021 BENEFIT SCHEDULE (CONTINUED)
A S HAPPY A HAPPY B HAPPY C HAPPY
Single Family Single Family Single Family Single Family
SAFE MALE
7 1,600 1,600 1,600 1,600
CIRCUMCISION
Subject to Managed Care Protocols. Global fee includes related costs of pre-operative testing and post operative care within one month of
the procedure
Adult
Adult Adult Adult
SEVERE ILLNESS P20,000
8 P20,000 P20,000 P20,000
BENEFIT Child P4,000
Child P4,000 Child P4,000 Child P4,000
˘ Refers to main member and spouse ˘˘ Refers to child dependant
EXECUTIVE
ANNUAL MEDICAL
EXAMINATION
(Per Beneficiary
no no no
9 - Limited to two no benefit no benefit no benefit 5000
benefit benefit benefit
family members)
(Tests covered as
per health plan)
10 WELLNESS BENEFIT REFER TO PAGE 22
FUNERAL
11
BENEFIT
Member/ Spouse/
11.1 8,000 10,000 10,000 10,000
Parent
Child dependant 14
11.2 10,000 10,000 10,000
- 21 years
Child dependant
11.3 5,000 5,000 5,000
6 - 13years
Child dependant
11.4 3,000
over 5 years
Child dependant
11.5 2,500 2,500 2,500 2,500
1 - 5 years
Child dependant
11.6 3,000 2,500 2,500 2,500
under 1 year
12 EMERGENCY MEDICAL SERVICES: Full cover through MRI Botswana Limited.
13 Travel Insurance 2,000 000 5,000 000
All Benefit limits are in Botswana Pula (BWP)
12THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
10 REASONS TO
JOIN BOMAID
REASON #10 REASON #5
FINANCIALLY STABLE TRAILBLAZING INNOVATION
Our 10 months of claims cover at the end of 2020 are Our self help technology channels provide convenience and
above the regional benchmark of 3 months and provide peace of mind. The Bomaid App and Web Portal provide 360
assurance that we have the financial stability to take care of degree member service whilst the newly launched Thobo
your health and happiness. internal platform facilitates better user experience through
fluid processes that result in shorter turn around times.
REASON #9
PROVEN EXPERIENCE REASON #4
We have over 50 years of value–driven experience in the REWARDING PARTNERSHIPS
medical aid industry and highly skilled personnel. We know all Our value adding partnerships with Virgin Active, Garmin and
about the business. Join us. Mosha Spa are designed for your wellness and happiness.
REASON #8
EX TENSIVE BENEFITS REASON # 3
We have the most comprehensive hospitalisation and out WIDEST PROVIDER NETWORK
patient cover including our travel insurance cover, screening We are the first medical aid fund to partner with
and embedded life products. internationally renowned Indian hospitals. Regionally and
locally, we connect our members to the widest network of
doctors, specialists, dentists, laboratories and many more.
REASON #7
COMPREHENSIVE PLANS REASON # 2
Our range of plans cater for individuals, large families
and corporates all the way from top tier (C Happy) to the CARE DRIVEN
affordable AS Happy for as little as P267 per month. We We have led the way by being responsive to members needs
have something for everyone. by way of introducing the Covid Care Benefit and Extended
Cover under the new Happy Student Plan.
REASON #6
LARGEST FUND REASON # 1
With over 87,000 lives covered and counting we are
Botswana’s largest open medical aid fund. There is security in MEMBER OWNED
our numbers. As a member, you have a say in the running of the affairs of
the medical aid fund. So join us today and become involved.
13THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
2021 NEW BENEFITS
Bomaid has endeavoured to align the 2021
benefit enhancements with the United
Nations Sustainable Development Goals
specifically on Health & Wellness.
* New benefits are bolded
Ensure access to essential medicines and
vaccines
• Extension of Flu Vaccine to all Bomaid members
• Provision of Vitamin B & Calcium supplements
to members aged 50 and above who are on
Chronic Medication.
Ensure access to reproductive
healthcare services
• Screening for chromosomal abnormalities for
Health Plans A, B & C.
• HPV Vaccine
• Infertility Investigations
Combat HIV/AIDS
and TB
• HIV Screening, Monitoring & Treatment
• ARV Treatment
• Prevention of Mother-to-child transmission
• Safe Male circumcision
• TB Medication
14THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
Reducing New-born & Child Mortality:
• Bombaby Maternity Program
• New Born metabolic screening and Thyroid-
Stimulating Hormone (TSH) Test .
Reduce global maternal mortality ratio
• Antenatal classes & Doctor’s visits
• 3 Obstetric Ultra Sound scans
• Iron & Folate supplements
Reduce mortality from non-
communicable diseases
• Dietician consultation without referral for members
with Body Mass Index over 35 with requirement of
referral from General Practitioner being waived.
• Strengthen prevention and treatment of substance
abuse
Strengthen prevention and
treatment of substance abuse
• Drug and alcohol rehabilitation benefit
15THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
VALUE
ADDED
BENEFITS
16THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
DREAD DISEASE
COVER
This ONCE-IN-A-LIFETIME COVER is offered in terms of rule 15 (1) of the Society rules and in
accordance with the levels defined below. Dread diseases covered under this benefit are as outlined
below:
CORONARY ARTERY DISEASE LEUKAEMIA
Dread disease benefit will ONLY be considered Dread disease benefit will ONLY be considered
where coronary arteries are severely narrowed where there is medical proof that the member
resulting in a need for coronary artery bypass requires bone marrow transplant . The benefit
surgery or open heart surgery. covers only the recipient BOMaid member.
Any other related treatments fall within
benefit 1.0
VALVULAR HEART DISEASE CANCER/MALIGNANT NEOPLASM
Dread disease benefit will ONLY be considered Dread disease benefit will ONLY be considered
where there is medical proof of severe where there is medical proof that the member
cardiac vulvular dysfunction needing a has a malignant type of cancer and requires a
surgical intervention such as valve repair or major surgical intervention.
replacement .
CEREBROVASCULAR ACCIDENT/STROKE CEREBRAL ANEURYSM - GRADE III TO V
Dread disease benefit will ONLY be considered Dread disease benefit will ONLY be considered
where there is medical proof that the where there is medical proof that the
member requires major surgical intervention aneurysm is of grade III or above and that the
such as craniotomy. This cover also includes member requires a major surgical intervention
rehabilitation therapy at an agreed daily or such as craniotomy or ligation of blood
global tariff for a period not exceeding 36 days. vessels. The benefit also covers rehabilitation
therapy at an agreed daily or global tariff for a
period not exceeding 36 days.
HEART FAILURE ORGAN TRANSPLANT
Dread disease benefit will ONLY be considered The benefit covers transplantation of the
where there is medical proof that the member following organs only: Heart , Bone Marrow,
requires major surgical intervention. Kidney, Liver, Lung and Pancreas. Cover is only
for the recipient Bomaid member.
END STAGE RENAL FAILURE SEVERE BURNS
Dread disease benefit will ONLY be considered Burns of multiple regions,at least one burn
where there is medical proof that the member of third degree mentioned: A severe burn
requires kidney transplant . The benefit covers involving >20% of the total body surface
only the recipient Bomaid member. or>10% in the elderly or very young; > 5% is
in full thickness
NOTE: IN ALL THE ABOVE, COVER IS FOR SURGICAL INTERVENTION AND OPERATION RELATED PROCEDURES.
MAINTENANCE THEREAFTER AND/OR TREATMENT BEFORE SURGERY FALL WITHIN BENEFIT 1.0
17THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
SEVERE ILLNESS
BENEFIT
This benefit is designed to provide a 100% cash payout to the life assured on 1st
diagnosis of any of the pre-defined severe illnesses regardless of the actual medical
expenses incurred.
The cash payout can be used among other things to:
a) Assist members with additional medical costs which might be above the allocated health plan limits.
b) Pay for alternative care or rehabilitation therapies not covered by the health plan.
c) Fund lifestyle changes that might be required following diagnosis and/or treatment of a severe illness.
The following severe illnesses are covered under this benefit:
Cancer Coma
Coronary Artery Disease Blindness
Heart Failure Loss of Hearing
Kidney Failure (Chronic) Major Burns
Major Organ Transplant (Kidney, Paraplegia
Lung, Liver, Heart , Pancreas)
Stroke Valvular Heart
Disease
The benefit has a termination age of 65 years.
by
18BOTSWANA SOUTH AFRICA
THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
Summary Benefits
Unlimited GP services
Unlimited medicines (chronic)
Ambulance for emergencies
Basic, fillings & extractions
R904 every 24 months
Get medical cover for study in South Africa
Switch to the HAPPY STUDENT Plan and pay just one
subscription for cover in both Botswana and South Africa.
The cover is FREE for all current Bomaid dependants.
.
Underwritten by
TRAVEL
INSURANCE
As part of your B Happy and C Happy benefits,
you are entitled to P2 million and P5 million
cover, respectively, for you and your family per
journey outside Botswana.
Underwritten by:
19THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
MANAGED CARE
PROGRAM
The program assists members with management of chronic conditions and includes
both benefit management and clinical advice. The following conditions are covered
under the program:
1 Allergic Rhinitis 17 HIV/AIDS
2 Arthritis 18 Hypercholesterolaemia
3 Ankylosing Spondylitis 19 Hypertension
4 Asthma 20 Bowel Disease
5 Benign prostate 21 Migraine (excludes acute
Hypertrophy attacks)
6 Bipolar Disorder 22 Macular Degeneration
7 Chronic Anxiety 23 Multiple Sclerosis
8 Chronic Depression 24 Osteopoenia
9 Chronic Bronchitis 25 Osteoporosis
10 Chronic Heart Diseases 26 Parkinson’s Disease
11 Chronic Renal Failure 27 Peptic Ulcer Disease
12 Chronic Obstructive 28 Psoriasis
Pulmonary Disease 29 Schizophrenia
13 Diabetes 30 Systemic Lupus
14 Epilepsy Erythematosus
15 Glaucoma 31 Thyroid Dysfunction
16 Hyperuricemia
HIV/AIDS IS COVERED UNDER THE HIV/AIDS ASSISTANCE PROGRAM WHICH IS FUNDED FROM A SPECIAL
BENEFIT FUND (SBF). PLEASE READ THE FOLLOWING REGARDING THIS PROGRAM:
a • Cover is for Bomaid members who have enrolled into the Bomaid HIV/AIDS Assistance Program.
• Registration is voluntary.
• Assistance is over and above the benefits shown in the different health plans.
• Cover includes ARV medications and laboratory monitoring.
b Bomaid will only cover ARV medications obtained from the designated pharmacies.
c Hospitalisation cover for HIV/AIDS related conditions is only available to members enrolled into the program.
20THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
CHRONIC AILMENT
PROGRAM REGISTRATION
Principal member/
patient collects Member and doctor
chronic ailment complete form
application form
Member submits
A letter confirming application and
approval is written prescription to Bomaid
and sent to member/ (email: managedcare@
patient bomaid.co.bw)
Member collects
medicine from any of the
designated pharmacies.
21THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
WELLNESS BENEFIT
This benefit is designed to help members with prevention and early detection of certain illnesses/
medical conditions. The benefit covers the following:
Breast Cancer Screening Cervical Cancer Screening Cardiovascular Disease Screening
Mammogram for women aged 40-70 years Pap smear test for women aged 25 – 55 Blood cholesterol test for members aged 35
once in two years. years once in two years. years and above once a year.
Diabetes Screening Glaucoma Screening Prostate Cancer Screening
Blood glucose test for members aged 35 years Screening test once a year for members Prostate Specific Antigen (PSA) test for men
and above once a year. HbA1c for diagnosed aged 40 years and above. Members with aged 40 years and above once in two years
diabetics bi-annually subject to Managed Care family history of glaucoma and members Care Protocols.
protocols. with diabetes.
HIV Aids Osteoporosis Flu Vaccine
HIV Rapid Test for members aged 16 Bone densitometry scan once every 2 Vaccination once a year for all Bomaid
years and above once a year. HIV Elisa test years for members aged 40 years and members.
(confirmatory test following a positive rapid above and members with family history of
test) for members aged 16 years and above. Osteoporosis. Only applicable to Health
Post Exposure Prophylaxis (PEP) for exposures Plans A Happy, B Happy & C Happy.
associated with high risk of infection. Cover
limited to occupational exposure
Malaria Prophylaxis Rabies Vaccine Tetanus Toxoid
For members of all ages (weight must be 20kg For members of all ages as and when For members of all ages as and when needed.
or more). Only applicable to Health Plans A needed. Only applicable to health plans A Only applicable to health plans A Happy, B
Happy, B Happy & C Happy. Happy , B Happy & C Happy. Happy & C Happy.
Notes: Benefits available only where service is given by Bomaid approved service providers. Managed Care, clinical protocols and plans rules
apply. 100% payout by plan. No 10 % copayment . No VAT. Bomaid tariffs strictly apply.
22THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
SCREENING LABS
FACILITY NAME EMAIL ADDRESS PHONE OWNER LOCATION
LAB CARE vtmakovore@gmail.com VT MAKOVORE FRANCISTOWN
DIAGNOSTICS
NORTHERN lkmotsisi@gmail.com; north- LK MOTSISI FRANCISTOWN
PATHOLOGY SERVICES ernpathologylab@hotmail.com;
TATI RIVER LAB kubisa@riversidehospital.co.bw KF MOMPATI FRANCISTOWN
DR LAMBAT dr_a_e_lambat@yahoo.com DR Lambat GABORONE
BOKAMOSO tshepo.kabelo@bokamosohos- BOKAMOSO PRIVATE GABORONE
PATHOLOGY pital.org HOSP
BOTSWANA bamsadventacc@gmail.com BOTSWANA GABORONE
MEDICAL AVENTIST ADVENTIST
DIAGNOFIRM MEDICAL LTEDO#GLDJQRǽUPFREZ A.H. CHAND GABORONE
LABORATORIES
CT DIAGNOSTICS LABS ctkekana@gmail.com CT KEKANA GABORONE
EKUSILENI CLINICAL ekusilenilab@gmail.com D NKOMO GABORONE
LABORATORY
LANCET rhadebe@lancet .co.za LANCET GABORONE
LABORATORIES
(GPH PATHOLOGY)
MEDIGEN palmgroveclinic@yahoo.com; E K MUTUTU GABORONE
LABORATORY edwinkmututu@gmail.com
MEDLANE tyler@medlane.co.bw DR T. LANE GABORONE
HEAL
THCARE
MEDLASS LAB keene.tiso@gmail.com R R MAKGEKGENENE GABORONE
MEGASCOPE meggascope@yahoo.com MEGASCOPE GABORONE
DIAGNOSTIC
MMOLOKI MEDICAL mmolokimedlabs@gmail.com MMOLOKI MOYO GABORONE
LAB
OPTIMUM HEAL
TH desire@optimumhealthlab. D MHLABI GABORONE
co.bw
PM AUTHENTICODI- rvurayai@gmail.com DR VURAYAI GABORONE
AGNOSTIC LAB
THE BIOLIVE rmubeda@biolive.co.bw R MUBENDA GABORONE
LABORATORY
QUALI-MED quali.med.labs@gmail.com IRENE DZINZA LOBATSE
LABORATORIES
DRS INN LAB tebtebogonhlatho@doctorsinn. TEBOGO NHLATHO MAUN
co.bw
PATHVIEW (PTY) L
TD pathviewlabs@gmail.com; P O BOX CK KHOSA MAUN
CLINIPATH clinipatlaboratories@gmail.com MOLEPOLOLE
LABORATORY
MEDI-PATH medipathbw@gmail.com; KOONE CHILUME PALAPYE
LABORATORY
VIA PATH LAB viapathlab@gmail.com; N K MBURUNGU SELEBE - PHIKWE
LABSCROLL MEDICAL ogbolepp@yahoo.com PAUL O TUTUME
DIAGNOSTIC
23THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
Introducing our new...
Member Benefits
Mosha Spa
Enjoy an exclusive 30% OFF full body massage
every Monday and 10% OFF all other services daily.
For enquiries call : 3164472.
Garmin
Virgin Active
Enjoy member-only exclusive discounts
of up to 36% OFF selected Garmin watches.
To order email : promotions@bomaid.co.bw
Enjoy an exclusive member-only 10% OFF
on monthly membership subscriptions.
For enquiries call : 3951200
COVID Care
Covers testing, treatment, and hospitalisation
for all Bomaid members until full recovery
(includes AS Happy). For enquiries please call
+267 363 3100.
24THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
PERSONAL Complete or
irrecoverable loss
ACCIDENT
of sight
1250 Min Cover
10,000 Max cover
DISABILIT Y Loss of ring finger
75 Min Cover
800 Max cover
Loss of index finger
100 Min Cover
1,200 Max cover
Loss of middle finger
75 Min Cover
800 Max cover
Loss of little finger
Loss of hearing 75 Min Cover
500 Min Cover 1,000 Max cover
5000 Max cover
Loss of thumb
250 Min Cover
Loss of or loss of 3,000 Max cover
use in one arm,
hand, leg or foot
2,500 Min Cover
10,000 Max cover Loss of toes
50 Min Cover
2,500 Max cover
PREMIUM WAIVER
This benefit pays medical aid contributions for the registered dependants
for a period of 12 months after the death of the principal member.
Financial freedom for the dependants. No additional cost to the main member.
Dependants do not have to make Guaranteed medical aid cover for the
monthly contributions themselves. remaining dependants.
by
25THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
Through Bombaby, we share with the
expectant family the excitement and
experience brought about by the new life
we are waiting for. The program offers:
Ante natal classes by
Clinical support ,
a designated service
education & advice
provider.
from the 12th week
of pregnancy.
Open discussions Early identification of
with an experienced high-risk pregnancy
midwife during the to enable the family
various stages of the to access medical
baby’s development . assistance where
necessary.
Tailor made A hamper with handy
information on any supplies for baby &
medical conditions mom.
in relation to the
pregnancy.
To register please submit your
form to bombaby@bomaid.co.bw
26THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
ADDITIONAL NOTES:
1. In-patient and Managed Care Benefits:
• Pre-authorisation is required for all cases. Health plan and/or managed care protocols will be applied.
• Post-admission step down cover includes sub-acute care, hospice, private nursing and physical rehabilitation for approved clinical
conditions. Excludes old age homes and frail care.
• Chronic medicines will be covered under the chronic medication benefit only if supplied through the Bomaid designated pharmacies.
Any chronic medicines supplied outside the designated pharmacies will be covered under the pharmacy benefit .
• No cover for ARVs supplied outside the Bomaid designated pharmacies.
2. Pharmaceutical Benefit Management
• Generic reference pricing (GRP) will apply to all health plans except C Happy.
• Under the GRP, a brand-name medicine that has a generic equivalent registered in Botswana and available at the point of service will be
reimbursed up to the tariff of the generic equivalent .
• Members will not pay the 10% co-payment should they opt to take the available generic medicines.
• Members will pay the difference between the tariff of the brand-name medicine and the generic equivalent should they opt to take the
brand-name medicine while there is an available generic equivalent .
3. Dental Benefit:
• Maximum 2 preventative treatments per beneficiary per annum (e.g. cleaning, scaling and polishing).
• Re-treatment (e.g. filling) of a tooth within one year will be subjected to managed care and clinical protocols.
• Cover excludes: orthognatic (jaw correction) surgery, professionally applied fluoride, dental bleaching and implants.
• Pre-authorisation is required for all in-hospital dental procedures as well as specialised dentistry (including orthodontic treatment ,
crowns, bridges and dentures). Pre-authorisation is not required for surgical procedures done under local anaesthesia in out-patient
rooms.
• A two-year benefit cycle applies for specialised dentistry (including orthodontic treatment , crowns, bridges and dentures).
4. Optical Benefit:
• A two year benefit cycle applies (excludes consultations).
5. Appliances Benefit:
• One wheel chair per beneficiary over a 3 year cycle.
• One pair of hearing aids per beneficiary over a 2 year cycle.
6. Allied Health Services Benefit:
• Occupational therapy, speech therapy and clinical psychology benefits exclude therapy for social, educational and developmental
problems.
• Alternative treatment claim payments will only be made to members and not service providers.
7. Safe Male Circumcision:
• Cover includes pre-operative consultation/counselling, physical examination, HIV test and post-operative care within 1 month of
operation.
8. Wellness Benefit:
• Annual health check applicable to members aged 35 years and above in health plans A, B and C only.
• Bone densitometry scan, tetanus toxoid, rabies vaccine and malaria prophylaxis applicable to health plans A, B and C only.
• No pre-authorisation required for screening and prevention benefits.
• 100% payout of the health plan tariffs. No copayment . No VAT.
9. Executive Annual Medical Examination:
• Covers principal member plus one (1) adult dependant per year. Cover includes physician consultation, physical examination including
cancer screening, blood work up, ECG, and non-invasive radiology. Excludes blood tumor markers and mammograms.
IN ALL BENEFIT CATEGORIES, ANY ONE FAMILY MEMBER CANNOT CLAIM IN EXCESS OF THE SINGLE MEMBER’S LIMIT.
27THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
2021
SUBSCRIPTIONS
*CD - Child Dependants ONLY
(0-25 Years of Age)
MEMBER AGE CATEGORY
18-35 36-49 50-55 56+
M 267 307 349 521
AS HAPPY PLAN
M+1 462 531 600 900
M+2 526 604 682 1025
M+3 604 694 786 1177
M+4+ 684 787 889 1333
M+CD1 439 504 570 855
M+CD2 500 574 648 974
M+CD3 574 659 747 1118
M + CD4+ 650 748 845 1266
MEMBER AGE CATEGORY
18-35 36-49 50-55 56+
M 777 791 816 858
M+1 1237 1259 1300 1366
A HAPPY PLAN
M+2 1360 1384 1430 1504
M+3 1572 1600 1652 1738
M+4+ 1712 1744 1800 1892
Per Parent 800 800 800 800
M+CD1 1175 1196 1235 1298
M+CD2 1292 1315 1359 1429
M+CD3 1493 1520 1569 1651
M + CD4+ 1626 1657 1710 1797
28THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
MEMBER AGE CATEGORY
18-35 36-49 50-55 56+
M 1360 1383 1428 1501
M+1 2255 2293 2369 2485
B HAPPY PLAN
M+2 2440 2481 2563 2692
M+3 2754 2799 2891 3035
M+4+ 3050 3100 3203 3363
Per Parent 1406 1406 1406 1406
M+CD1 2142 2178 2251 2362
M+CD2 2318 2357 2435 2557
M+CD3 2616 2659 2746 2883
M + CD4+ 2898 2945 3043 3195
MEMBER AGE CATEGORY
18-35 36-49 50-55 56+
M 1976 2272 2766 4050
M+1 3260 3520 4286 5624
C HAPPY PLAN
M+2 3398 3658 4397 5426
M+3 3595 3862 4673 5709
M+4+ 3842 4134 4991 6155
Per Parent 4050 4050 4050 4050
M+CD1 3097 3344 4072 5001
M+CD2 3228 3475 4177 5155
M+CD3 3415 3669 4439 5424
M + CD4+ 3650 3927 4741 5847
These rates are applicable to individual members. Companies and corporate
members are advised to contact Bomaid for a quotation.
29THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
FREQUENTLY
ASKED QUESTIONS
Q. HOW DO I JOIN BOMAID MEDICAL AID?
A. Joining Bomaid is easy. Simply log onto http://bomaid.co.bw/join-us/or dial 3633100 for more assistance and to
get a quote.
Q. WHAT IS THE DIFFERENCE BET WEEN A BENEFIT AND A LIMIT ?
A. A benefit is a pool of funds in a medical health plan reserved for specific healthcare services. For example, the
Hospital Benefit pays for healthcare services when you are admitted to hospital as part of an approved admission.
A limit is the maximum amount or a cap on what we will pay for a particular type of healthcare service. This applies
when the service is paid from a specific benefit . For example, your dental claims pay from the Dental Benefit but we
will only pay these claims up to the Dental limit for your health plan.
Q. HOW DO I REGISTER MY NEWBORN BABY ?
A. For your baby not to be subjected to the three month waiting period, you need to register your child within
seven (7) calendar days from date of birth. Contact us immediately to register your child. You need to complete an
‘Additional Dependant Form’ which is also called ‘Medical History Form B3’ and submit it to us to ensure that your
baby is covered and attach a copy of birth certificate.
Q. I AM A SINGLE GENTLEMAN WHO RECENTLY HAD A BABY BOY WITH MY LONG-TIME
GIRLFRIEND. CAN HE BE REGISTERED AS MY DEPENDANT ?
A. Absolutely! Any male applicant or male member wishing to register children born out of wedlock can simply attach
an affidavit certified by the police for that child to the additional member application form (B3). Or simple provide a
birth certificate of the child with your name on it .
Q. WHAT DO I DO IN AN EMERGENCY ?
A. In any emergency, you can call MRI on 992 at no charge. Or you can visit any of our contracted service providers
either a GP or specialist to get the assistance you need.
Q. AM I COVERED WHEN I TRAVEL OUTSIDE BOTSWANA?
A. Yes, we have a travel cover for members who are in the Plan B Happy and Plan C Happy. The Travel Cover offers
medical emergency cover for 90 days from date of departure outside the borders of Botswana. Kindly contact us on
3633100 for more information on these plans.
30THE HAPPY AND HEALTHY PLAN BENEFIT GUIDE 2021
OUR SELF-SERVICE
CHANNELS
Please access the Bomaid App (Google Play for Android) and
Web App (www.bomaid.co.bw).
Our Call Centre: +267 363 3100
Whatsapp: +267 7624 2213
We also have the following designated email addresses :
• General enquiries - bomaid@bomaid.co.bw
• Claims submissions - claimsubmissions@bomaid.co.bw
• New applications - newapp@bomaid.co.bw
• Membership amendments - membership@bomaid.co.bw
• Chronic ailments - managedcare@bomaid.co.bw
• Payments, EFT& Direct debits: creditcontrol@bomaid.co.bw
For hospital admissions call 71300036 and 992 for
emergencies.
31 Bomaid - Botswana Medical Aid Society
Bomaid_healthandhappiness
Bomaid - Botswana Medical Aid Society
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