THE HAPPY & HEAL THY PLAN BENEFIT GUIDE - "A happy mind is a healthy mind, and a healthy mind is good for the body."
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THE HAPPY
& PLAN
HEAL THY
BENEFIT GUIDE
“A happy mind is a healthy
mind, and a healthy mind is
good for the body.”
Your happiness is a reflection of your health
Table of Contents Plans Summary 4 A Health Plan Benefit 9-15 Dread Disease Benefit 16-22 Managed Care Program 23 Additional Notes 24
4
PLANS
SUMMARY
“Happiness: What you think
What you say, what you do,
in harmony”
AS Happy A Happy B Happy C Happy
Previously Scheme AS Previously Scheme A Previously Scheme B Previously Scheme C
If you’re looking for a This plan is ideal for A comprehensive plan This executive top tier
low cost , no co-payment young, healthy couples that includes a newly plan gives you and your
plan then AS Happy is and individuals. It introduced Travel loved ones elite cover
the right plan for you. provides adequate and Insurance Cover. Getting for hospital, chronic,
This plan offers an array affordable cover that this plan gives you and screening and value
of outpatient benefits. aims to liberate mem- your family peace of mind added benefits.
This plan is ideal if you’re bers from the worry of as it provides a broad
young, healthy and unexpected conditions. dashboard of benefits to C Happy Benefits
looking to acquire basic ensure total health and
cover. Members A Happy Benefits happiness. • Inpatient and
pay VAT only. Managed Care
• Inpatient and B Happy Benefits Benefits
AS Happy Benefits Managed Care • Inpatient and • Medical/ Surgical
Benefits Managed Care Outpatient Benefits
• Chronic Ailment • Medical/ Surgical Benefits • Dental and Oral
Benefits Outpatient • Medical/ Surgical Benefits
• Medical/ Surgical Benefits Outpatient Benefits • Optical Benefits
Outpatient Benefits • Dental and Oral • Dental and Oral • Safe Male
• Dental and Oral Benefits Benefits circumcision
Benefits • Optical Benefits • Optical Benefits • Appliances
• Appliances Benefits • Safe Male • Safe Male • Allied Health
• Allied Health circumcision circumcision Services
Services Benefits • Appliances • Appliances • Wellness Benefit
• Funeral Benefits • Allied Health • Allied Health • Funeral Benefit
• Screening & Services Services • Executive Annual
Prevention Benefits • Wellness Benefit • Wellness Benefit Medical Examination
• Funeral Benefit • P5 million Travel
• P2 million Travel Cover
Cover
5
5 REASONS
TO JOIN BOMAID
50 years Experience. Bomaid has 50 years
of value –driven experience in the medical aid
industry. We bring you and your loved ones
unrivalled member-centred health and happiness.
Stability. Bomaid’s solvency rate is consistently
well above the industry requirement . Being self-
administered allows for reduced administration
costs and a hands-on approach.
Comprehensive Plans. We focus on fulfilling
your health and wellness needs by customising our
products and services to ensure a superior experience.
Our plans offer a range of well thought benefits that
cater for individuals, large families and corporates.
From basic healthcare needs to the more involving
health profiles, we have you covered!
Value Added Benefits. We provide cover for
chronic conditions such as Cancer, Mental Health,
HIV/AIDS and Diabetes through our Managed
Care Program. Other value added benefits include
Premium Waiver, Funeral Cover, Dreaded Disease
and Travel Insurance Cover, to name a few - we aim
to give you peace of mind.
5
Largest Fund. Bomaid is Botswana’ largest
open medical aid. Our customer base continues to
grow at a steady and sustainable rate contributing
to a healthy fund pool.
5
6 2020 BENEFIT SCHEDULE “Happiness is the art of never holding in your mind the memory of any unpleasant thing that has passed.”
2020 BENEFIT
SCHEDULE
SCHEME AS Happy A Happy B Happy C Happy
Single Family Single Family Single Family Single Family
OVERALL SCHEME
37,790 44,568 274,145 290,772 866,532 1,009,686 1,351,121 1,785,000
BENEFIT LIMIT
IN-PATIENT AND
MANAGED CARE
1 236,250 252,000 813,225 931,350 1,249,500 1,485,750
BENEFITS OVERALL
LIMIT B E N E F I T
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:
• Neonatal hospitalisations
• Doctors and 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/
Brachytherapy
N O
• Renal Dialysis
Mental Health hospitalization
(includes Alcohol & Drug
1.2.1.1 15,750 15,750 42,000 52,500 53,000 70,000
rehabilitation ) includes
Professional fees
Sub-acute care /nursing
home & home-based care*
1.2.1.2 15,000 28,000 43,000
(alternative to hospital -
maximum 30 days)
B E N E F I T
In-patient Dental Overall
Cover includes:
No No Up to Up to Up to Up to
1.2.1.3
• Hospital fees benefit benefit 51,600 103,200 65,000 130,000
• Dentist Fees
• Anaesthetist fees
Simple maxillo-facial Up to Up to Up to Up to
14,000 20,000
surgery: acute or chronic * 51,600 103,200 65,000 130,000
1.2.2 Internal/External Prosthesis 10,000 15,000 60,000 80,000 80,000 100,000
Normal delivery
hospitalisation fees (include
1.2.3 3,675 3,675 9,450 9,450 9,450 9,450
forceps delivery and vacuum
extraction)
N O
Caesarian section delivery
1.2.3.1 6,825 6,825 13,650 13,650 14,700 14,700
hospitalisation fees
Birthing unit delivery global
1.2.3.2 fee (by a registered unit/ 788 788 2,100 2,100 2,100 2,100
facility)
7
8
2020 BENEFIT
SCHEDULE C O N T I N U E D
SCHEME AS 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 with the Bomaid
1.2.3.3 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 Programme required
Extended chronic medication
1.2.3.5 benefit * ^ (cover on 5,250 6,300 18,900 22,050 25,200 33,600
assessment)
ARV medications per
beneficiary * (supplied
1.2.3.6 through the Managed Care 12,600 12,600 12,600 12,600
Program) Registration with
the Bomaid
Managed Care Programme
Required
Laser refractive eye
surgery * (referrals from
no no
1.2.3.7 approved Ophthalmologist/ 2,646 3,528 4,725 5,775 5,775 6,825
benefit benefit
Optometrist) per beneficiary
per annum
° Guar- ^ Cover on assessment
anteed *Pre-authorisation required
MEDICAL/SURGICAL
OUT-PATIENT
OVERALL LIMIT
2 (Consultations, 16,790 23,568 27,000 34,000 58,000 65,000 65,000 90,000
Medications,
Investigations and
Procedures)
(within the above overall
limit, the following sub-
limits will apply i.e. 2.1
to 2.5)
Consultations (GPs and
Specialists. Includes ante-
natal visits, examination and
2.1 3,129 4,064
two subsequent follow-
up appointments of the
newborn baby)
Antenatal Classes (by a
2.2 contracted/approved service 1200 1200 3visits 4visits 4visits
provider)
Registration with the
Bombaby Program
Required(exclude limit and
indicate number of visits)
Drugs/Prescribed Medicine
2.3 3,491 4,935 3,950 5,400 7300 11600 15000 19200
Limit
Self medication (prescribed
2.3.1 105 210 200 400 300 600 500 700
by pharmacist)
2020 BENEFIT
SCHEDULE C O N T I N U E D
SCHEME AS Happy A Happy B Happy C Happy
Single Family Single Family Single Family Single Family
Doctor dispensed medicine
2.3.2 525 788 750 1,000 1000 2,000 2,500 3,500
(for acute cases only)
Pharmacy dispensed
medicine (includes dental
2.3.3 2,625 3,938 3,000 4,000 6,000 9,000 12,000 15,000
and ophthalmic prescribed
medications)
ARV medications per bene-
ficiary (subject to eligibility
2.3.4 6,300 6,300 6,300 6,300
criteria, refer to Notes on
Page 16)
Diagnostic/Investigative
Procedure Cover includes:
• X-Ray/Ultrasound scans
• (excludes 3 obstetric
2.4 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/
2.4.1 tests excluding HIV 1,139 1,657
monitoring
HIV laboratory monitoring
per beneficiary (subject to
2.4.2 3,500 3,500 3,500 3,500
eligibility criteria, refer to
Notes on Page 16)
HIV laboratory monitoring
2.4.2.1 1,750 1,750 1,750 1,750
per beneficiary
Infertility diagnostic proce-
2.4.3 dures (limited to Outpatient no benefit no benefit no benefit no benefit 8,000 11,000
Investigations).
Medical/Surgical Procedure
Cover indcludes:
• Minor medical procedures
2.5 • Minor surgical procedures 4,673 6,694 5,000 7,000 9,000 12,000 12,000 18,000
• Major procedures
(ambulatory)
* Pre-authorisation required ^ Cover on assessment
DENTAL AND ORAL
3 BENEFIT OVERALL 2,268 3,187 14,500 20,500 35,000 50,000 45,000 55,000
LIMIT
Out-patient Dental Overall
Cover Includes:
• Basic dentistry (includes
consultations, radiology
filling, extraction,
cleaning, scaling and
3.1 polishing,incision and 2,268 3,187 14,500 20,500 35,000 50,000 45,000 55,000
drainage,root canal
treatment
• Specialised dentistry *
(includes crowns, bridges
and dentures) and oral
surgery
9
10
2020 BENEFIT
SCHEDULE C O N T I N U E D
SCHEME AS Happy A Happy B Happy C Happy
Single Family Single Family Single Family Single Family
Orthondontic treatment for
members up to 35 years of Up to Up to
3.1.3 10,500 15,750 23,000 37,000 35,000 48,000
age * ˜ (braces, retainers and 2,268 3,187
related appliances)
* Pre-authorisation required - Treatment every 2 years ˜ Refers to treatment once in a lifetime
Optical Benefit Cover
includes (2year benefit
cycle per beneficiary)
• Clear aquity single vision 210
lenses (per lens)
• Clear aquity bifocal lenses 555
(per lens)
4
• Clear aquity multifocal 705
Up to Up to Up to
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 and lenses per 1,200
annum subject to benefit
availabilty)
APPLIANCES
5,250 6,195 7,000 15,000 15,000 20,000 21,000 26,000
OVERALL LIMIT
COVER INCLUDES:
• General apliance
• Medical appliances
• Surgical appliances
• Wheel chairs, crutches
and walking frames (for
5 permanent disability)
• Hearing aid (prescription Up to Up to Up to Up to Up to Up to
required) (maximum 1 pair 1,025
7,000 15,000 15,000 20,000 21,000 26,000
of appliances per 2 year
cycle)
• CPAP machines, home
oxygen, stoma products
(CPAP machines and
home oxygen cover subject
to pre-authorisation and
scheme protocols)
ALLIED HEALTH
2,909 4,541 3,000 5,000 8,000 13,000 12,000 18,000
SERVICE COVER
INCLUDES:
6 Rehabilitation Therapy
Podiatry
Occupational therapy Up to Up to Up to Up to Up to Up to
1,061 1,680
Speech therapy 3,000 5,000 8,000 13,000 12,000 18,000
Clinical psychology
Clinical dietetics2020 BENEFIT
SCHEDULE C O N T I N U E D
SCHEME AS Happy A Happy B Happy C Happy
Single Family Single Family Single Family Single Family
Alternative Treatment
Cover Includes:
6.2
Homeopathic treatment
6.2.1
Chiropractic treatment
6.2.2
Naturopathic treatment Up to Up to Up to Up to Up to Up to
6.2.3 788 1,181
Acupuncture treatment 1,500 2,500 1,500 2,500 1,500 2,500
6.2.4
Biokinetics
6.2.5
Traditional healing (cover
6.2.6
strictly limited to Ngope,
Thobega and Mototwane)
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
SEVERE ILLNESS
8
BENEFIT
˘ Refers to main member and spouse ˘˘ Refers to child dependant
EXECUTIVE
ANNUAL MEDICAL
no no no no no no
9 EXAMINATION (Per 5000
benefit benefit benefit benefit benefit benefit
Beneficiary - Limited
to two family members)
(Tests covered as per health
plan)
10 WELLNESS BENEFIT
11 FUNERAL BENEFIT
11.1 Member/ Spouse/ Parent 8,000 10,000 10,000 10,000
Child dependant 14 - 21
11.2 10,000 10,000 10,000
years
11.3 Child dependant 6 - 13years 5,000 5,000 5,000
11.4 Child dependant over 5 years 3,000
11.5 Child dependant 1 - 5 years 2,500 2,500 2,500 2,500
Child dependant under
11.6 3,000 2,500 2,500 2,500
1 year
12 EMERGENCY MEDICAL SERVICES: Full cover through MRI Botswana Limited.
13 Travel Insurance 2,000 000 5,000 000
1112 VALUE ADDED BENEFITS “Very little is needed to make a happy life; it is all within yourself, in your way of thinking.”
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 VALVULAR HEART CEREBRO END STAGE
ARTERY HEART FAILURE VASCULAR RENAL
DISEASE DISEASE ACCIDENT/ FAILURE
Dread disease STROKE
Dread disease benefit will ONLY be Dread disease
Dread disease benefit will ONLY be Dread disease
considered where benefit will ONLY be benefit will ONLY
benefit will ONLY considered where there is medical be considered
considered where
be considered there is medical proof that the where there is
there is medical proof
where coronary proof of severe member requires that the member medical proof
arteries are severely cardiac vulvular major surgical requires major surgical that the member
narrowed resulting dysfunction intervention such requires kidney
in a need for needing a surgical as craniotomy. This
cover also includes transplant. The
coronary artery intervention such benefit covers
bypass surgery or rehabilitation therapy
as valve repair or at an agreed daily or only the recipient
open heart surgery. replacement. global tariff for BOMaid member.
a period not exceeding
36 days.
LEUKAEMIA CANCER/ CEREBRAL ORGAN SEVERE
MALIGNANT ANEURYSM TRANSPLANT BURNS
Dread disease NEOPLASM GRADE
benefit will ONLY be
considered where
III TO V The benefit covers
transplantation of the
Burns of multiple
regions,at least
Dread disease Dread disease benefit
there is medical following organs only: one burn of third
benefit will ONLY will ONLY be considered
proof that the Heart, Bone Marrow, degree mentioned:
be considered where there is medical Kidney, Liver, Lung
member requires where there is proof that the aneurysm A severe burn
and Pancreas. Cover is
bone marrow medical proof that is of grade III or above involving >20%
only for the recipient
transplant. The the member has a and that the member of the total body
Bomaid member.
benefit covers malignant type of requires a major surgical surface or>10% in
only the recipient cancer and requires intervention such as the elderly or very
BOMaid member. a major surgical craniotomy or ligation young; > 5% is in
Any other related intervention. of blood vessels. The full thickness
treatments fall benefitalso covers
within benefit 1.0 rehabilitation therapy at
an agreed daily or global
tariff for a period not
exceeding 36 days.
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
1314
THE SEVERE
ILLNESS BENEFIT
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:
a. Assist members with b. Pay for alternative care or c. Fund lifestyle changes that
additional medical costs rehabilitation therapies not might be required following
which might be above the covered by the scheme diagnosis and/or treatment of
allocated scheme limits a severe illness
The following severe illnesses are covered under this benefit:
Cancer Coronary Heart Kidney Major Organ
Artery Failure Failure T ransplant
Disease (Chronic) (Kidney, Lung,
Liver, Heart ,
Pancreas)
Stroke Coma Blindness Loss of
Hearing
Major
Burns Paraplegia Valvular
Heart
Disease
This Benefit is only offered to
A,B and C Happy Plan members
underwritten by: The benefit
has a termination
age of 65 years.
byTRAVEL
INSURANCE COVER
As part of your Be Happy and C Happy
benefits, you are entitled to P2 million
and P5 million cover for you and your
family per journey outside Botswana.
This travel cover is in partnership with
Hollard.
Be Happy Travel Insurance C Happy Travel Insurance
underwritten by: underwritten by:
1516
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 Hyperuricemia 16
(only if associated with HIV/AIDS 17
asthma)
Hyperchole- 18
2 Arthritis sterolaemia
3 Ankylosing Hypertension 19
Spondylitis
Inflammatory 20
4 Asthma Bowel Disease
5 Benign prostate Migraine (excludes 21
Hypertrophy acute attacks)
6 Bipolar Disorder Macular Degeneration 22
7 Chronic Anxiety Multiple Sclerosis 23
8 Chronic Depressior Osteopoenia 24
9 Chronic Bronchitis Osteoporosis 25
10 Chronic Heart Parkinson's Disease 26
Diseases
Peptic Ulcer Disease 27
11 Chronic Renal Failure
Psoriasis 28
12 Chronic Obstructive
Pulmonary Disease
Schizophrenia 29
13 Diabetes Systemic Lupus 30
Erythematosus
14 Epilepsy
Thyroid Dysfunction 31
15 Glaucoma
NOTE: 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 i Cover is for Bomaid members who have enrolled into the Bomaid HIV/AIDS Assistance Program.
ii Registration is voluntary.
iii Assistance is over and above the benefits shown in the different schemes/health plans.
iv 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.HIV ASSISTANCE
PROGRAM
3
1 2
Use Your Wellness Benefit Diagnosed negative Dr. notifies
Get tested at Laboratory / member advised to Bomaid to check
General Practitioner continue living healthy! for eligibility
Diagnosed Positive
4
6 5
Initial contact with Dr. carries out If eligible member
Counsellor for Baseline investigations is registered into
Pre-initiation into (e.g. Viral load, CD4 the programme
the programme count etc)
9
8
Upon authorization,
Dr. completes & Application undergoes
7
member & Dr. are
submits the Adjudication and
notified via telephone /
Precertification Approval by Bomaid
email or face to face.
form to Bomaid
Initiation Counselling 10
Member is now eligible
12 11
The Pharmacist
is done by the to receive treatment
will advise on
Counsellor & from Designated Service
the next visit
Pharmacist Provider (DSP)
13
Quarterly / bi-annual
check up with Dr. for
programme adherence
On going
Supportive
14
Counselling for the
duration of the
15
Failure to adhere to
program will result in
Bomaid unable to honour
claims associated with illness
membership
17• No 10%
18 Copayement
• No VAT
WELLNESS
BENEFIT
This benefit is designed to help members with prevention and early detection of
certain illnesses/medical conditions. The benefit covers the following:
1. Breast Cancer 2. Cervical Cancer 3. Cardiovascular
Screening: Screening: Disease Screening:
Mammogram for women aged Pap smear test for women aged Blood cholesterol test for members
40-70 years once in two years. 25-55 years once in two years. aged 35 years and above once a year.
4. Diabetes 5. Glaucoma 6. Prostate
Screening: Screening: Cancer Screeing:
Blood glucose test for Screening test once a year for Prostate Specific Antigen (PSA) test
members aged 35 years and members aged 40 years and for men aged 40 years and above
above once a year. HbA1c for above, members with family once in two years.
diagnosed diabetics- bi annually history of glaucoma and
subject to Managed Care members with diabetes.
Protocols.
7. HIV AIDS: 8. Osteoporosis: 9. Flu Vaccine:
HIV rapid test for members Bone densitometry scan once Vaccination once a year for members
aged 16 years and above every 2 years for members aged aged 10 years and below, members
once a year. HIV Elisa test 40 years and above aged 65 years and above and
(confirmatory test following a and members with family history members with certain chronic
positive rapid test) for members of oesteoporosis. Only applicable conditions (e.g. chronic respiratory
aged 16 years and above.Post to health plans A, B & C. diseases, chronic pulmonary
Exposure Prophylaxis (PEP) for obstructive diseases, chronic heart
exposures associated with high diseases, chronic kidney diseases,
risk of infection. Cover limited diabetes, HIV/AIDS etc.)
to occupational exposure.
10. Malaria Prophylaxis: 11. Rabies Vaccine: 12. Tetanus Toxoid:
For members of all ages ( For members of all ages as and For members of all ages as and
weight must be 20kg or more). when needed. Only applicable to when needed. Only applicable to
Only applicable to health plans health plans A, B & C. health plans A, B & C.
A, B & C.
Notes: Benefits available only where service is given by Bomaid approved service providers. Managed care,
clinical protocols and scheme rules apply. 100% payout by scheme. No 10% copayment . No VAT. Bomaid tariffs
strictly apply.SCREENING LABS
FACILITY NAME EMAIL ADDRESS PHONE OWNER LOCATION
LAB CARE vtmakovore@gmail.com 2484037 VT MAKOVORE FRANCISTOWN
DIAGNOSTICS
NORTHERN lkmotsisi@gmail.com; north- 2410735/ LK MOTSISI FRANCISTOWN
PATHOLOGY SERVICES ernpathologylab@hotmail.com; 71630518
TATI RIVER LAB kubisa@riversidehospital.co.bw 2412518 KF MOMPATI FRANCISTOWN
DR LAMBAT dr_a_e_lambat@yahoo.com 3953233 DR Lambat GABORONE
BOKAMOSO tshepo.kabelo@bokamosohos- 3694000 BOKAMOSO PRIVATE GABORONE
PATHOLOGY pital.org HOSP
BOTSWANA bamsadventacc@gmail.com 3951515 BOTSWANA GABORONE
MEDICAL AVENTIST ADVENTIST
DIAGNOFIRM MEDICAL iqbal@diagnofirm.co.bw; 71320331/ A.H. CHAND GABORONE
LABORATORIES 3950007
CT DIAGNOSTICS LABS ctkekana@gmail.com 3184210 CT KEKANA GABORONE
EKUSILENI CLINICAL ekusilenilab@gmail.com 72148209/ D NKOMO GABORONE
LABORATORY 3916420
LANCET rhadebe@lancet .co.za 71846540 LANCET GABORONE
LABORATORIES
(GPH PATHOLOGY)
MEDIGEN palmgroveclinic@yahoo.com; 71678163/ E K MUTUTU GABORONE
LABORATORY edwinkmututu@gmail.com 3500767
MEDLANE tyler@medlane.co.bw 3184970 DR T. LANE GABORONE
HEALTHCARE
MEDLASS LAB keene.tiso@gmail.com 71692933/ R R MAKGEKGENENE GABORONE
3913843
MEGASCOPE meggascope@yahoo.com 3972662/ MEGASCOPE GABORONE
DIAGNOSTIC 74610109
MMOLOKI MEDICAL mmolokimedlabs@gmail.com 3938705/ MMOLOKI MOYO GABORONE
LAB 71415742
OPTIMUM HEALTH desire@optimumhealthlab. 3926912/ D MHLABI GABORONE
co.bw 74092214
PM AUTHENTICODI- rvurayai@gmail.com 3115469 DR VURAYAI GABORONE
AGNOSTIC LAB
THE BIOLIVE rmubeda@biolive.co.bw 71847233 R MUBENDA GABORONE
LABORATORY
QUALI-MED quali.med.labs@gmail.com 5330625 IRENE DZINZA LOBATSE
LABORATORIES
DRS INN LAB tebtebogonhlatho@doctorsinn. 6865115 TEBOGO NHLATHO MAUN
co.bw
PATHVIEW (PTY) LTD pathviewlabs@gmail.com; P O BOX CK KHOSA MAUN
350092
CLINIPATH clinipatlaboratories@gmail.com 3947923 MOLEPOLOLE
LABORATORY
MEDI-PATH medipathbw@gmail.com; 4920909/ KOONE CHILUME PALAPYE
LABORATORY 72715046
VIA PATH LAB viapathlab@gmail.com; 72266712/ N K MBURUNGU SELEBE - PHIKWE
2610033
LABSCROLL MEDICAL ogbolepp@yahoo.com 2417240 PAUL O TUTUME
DIAGNOSTIC
1920
PREMIUM
WAIVER
This benet pays medical aid contributions for the registered
dependants for a period of 12 months after the death of the
principal member. Value to the member:
Financial freedom Dependants do No additional Guaranteed medical aid
for the dependants. not have to make cost to the cover for the remaining
monthly contributions main member. dependants.
themselves.
“The moments of
happiness we enjoy
take us by surprise. It is
not that we seize them,
but that they seize us.”
byPERSONAL
ACCIDENT
DISABILITY COMPLETE OR
COVER
IRRECOVERABLE
LOSS OF SIGHT
1250 10,000
MIN COVER MAX COVER
LOSS
OF HEARING
LOSS OF
500 5000 THUMB
MIN COVER MAX COVER
250 3000
MIN COVER MAX COVER
LOSS OF
INDEX FINGER LOSS OF RING
FINGER
100 1200 75 800
MIN COVER MAX COVER
MIN COVER MAX COVER
LOSS OF
LOSS OF LITTLE FINGER
MIDDLE FINGER
75 800 75 100
MIN COVER MAX COVER
MIN COVER MAX COVER
LOSS OF LOSS OF OR LOSS OF
TOES USE IN ONE ARM, HAND ,
LEG OR FOOT
50 2500 2500 10,000
MIN COVER MAX COVER
MIN COVER MAX COVER
by 2122
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. 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. 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
7Days after s/he is born. 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.What do I do in an emergency?
A.In any emergency, you can call the contracted EMS 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. Our agreements cover 90% of GP and
specialists visits respectively.
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/ 251 for more information on these plans.
Alternatively, members who travel outside Botswana and are not B Happy and C Happy members, will be subject
to Bomaid’s ‘Foreign Claim Processing’ requirements as indicated under ‘Claim Reimbursement’23
ADDITIONAL NOTES & INFORMATION
1. In-patient and Managed Care Benefits: 4. Optical Benefit:
• Pre-authorisation is required for all cases. Scheme • A two year benefit cycle applies (excludes
and/or managed care protocols will be applied. consultations).
• Post-admission step down cover includes sub-
acute care, hospice, private nursing and physical
rehabilitation forapproved clinical conditions. 5. Appliances Benefit:
Excludes old age homes and frail care.
• One wheel chair per beneficiary over a 3 year cycle.
• Chronic medicines will be covered under the chronic
• One pair of hearing aids per beneficiary over a 2
medication benefit only if supplied through the
year cycle.
Bomaid designated pharmacies. Any chronic
medicines supplied outside the designated
pharmacies will be covered under the pharmacy
benefit . 6. Allied Health Services Benefit:
• No cover for ARVs supplied outside the Bomaid
designated pharmacies. • Occupational Therapy, Speech Therapy and Clinical
Psychology benefits
• Alternative treatment claim payments will only be
made to members and not service providers.
2. Pharmaceutical Benefit Management: • Drug and Alcohol Abuse Treatment
• Generic reference pricing (GRP) will apply to all
schemes except Scheme C.
• Under the GRP, a brand-name medicine that has 7. Safe Male Circumcision:
a generic equivalent registered in Botswana and
available at the point of service will be reimbursed up
to the tariff of the generic equivalent . • Cover includes pre-operative consultation/
• Members will not pay the 10% co-payment should counselling, physical examination, HIV test and
they opt to take the available generic medicines. post-operative care within 1 month of operation.
• 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 8. Wellness Benefit:
equivalent .
• Annual health check applicable to members aged 35
years and above in health plans A, C and C only.
3. Dental Benefit: • Bone densitometry scan, tetanus toxoid, rabies
vaccine and malaria prophylaxis applicable to health
• Maximum 2 preventative treatments per beneficiary plans A, B and C only.
per annum (e.g. cleaning, scaling and polishing). • No pre-authorisation required for screening and
• Re-treatment (e.g. filling) of a tooth within one year prevention benefits.
will be subjected to managed care and clinical • 100% payout of the scheme tariffs. No
protocols. copayment . No VAT.
• Cover excludes: orthognatic (jaw correction) surgery,
professionally applied fluoride, dental bleaching and
implants.
• Pre-authorisation is required for all in-hospital
9. Executive Annual Medical Examination:
dental procedures as well as specialised dentistry
• Covers principal member plus one (1) adult
(including orthodontic treatment , crowns, bridges
dependant per year. Cover includes physician
and dentures). Pre-authorisation is not required for
consultation, physical examination
surgical procedures done under local
including cancer screening, blood work up,
anaesthesia in out-patient rooms.
ECG, and non-invasive radiology. Excludes blood
• A two-year benefit cycle applies for specialised
tumor markers and mammograms.
dentistry (including orthodontic treatment , crowns,
bridges and dentures).
IN ALL BENEFIT CATEGORIES, ANY ONE FAMILY MEMBER
CANNOT CLAIM IN EXCESS OF THE SINGLE MEMBER’S LIMIT.
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