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Bomaid Healthplan Guide 2018 At the heart of health.PB 1

Benefits Guide & Rates

Value Add Benefits 5-9

A Health Plan 11-15

A Health Plan Subscription Rates 16

B Health Plan 17-21

B Health Plan Subscription Rates 22

Dread Disease Benefit 23 Managed Care Program 24

HIV/AIDS Assistance Program 25

Additional Notes 26-27

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2018 Rates & Benefits Guide

matters

Family health

Contents

Bomaid Healthplan Guide 2018 At the heart of health.2 3

Bomaid for healthier, happier

lives.Through diverse health plans, Bomaid offers a comprehensive

set of solutions that cater for the health and wellness needs of your life.

Health Plans

AS AS

Healthplan

C C

Healthplan

B

Healthplan

B

Healthplan

B

A A

Healthplan

A

S HealthplanIS IS

Healthplan

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 scheme limits

b) Pay for alternative care or rehabilitation therapies not covered by the scheme

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

Coronary Artery Disease

Heart Attack

Kidney Failure (Chronic)

Major Organ Transplant (Kidney, Lung, Liver, Heart , Pancreas)

Stroke

The benefit has a termination age of 65 years. T’s & C’s Apply

Value Add Benefits


Value Add Benefits

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. Annual Health Check: - For members ages 35 years and above once a year. Only applicable to health plans A, B & C. Includes consultation and examination.

2. Breast Cancer Screening: - Mammogram for women aged 40-70 years once in two years.

3. Cervical Cancer Screening: - Pap smear test for women aged 25-55 years once in two years.

4. Cardiovascular Disease Screeing: - Blood cholesterol test for members aged 35 years and above once a year.

5. Diabetes Screening: - Blood glucose test for members aged 35 years and above once a year.

6. Flu Vaccine: - Vaccination once a year for members aged 10 years and below, members aged 65 years and above and members with certain chronic conditions (e.g. chronic respiratory diseases, chronic pulmonary obstructive diseases, chronic heart diseases, chronic kidney diseases, diabetes, HIV/AIDS etc.)

7. Glaucoma Screening: - Screening test once a year for members aged 40 years and above, members with family history of glaucoma and members with diabetes.

8. HIV AIDS Screening: - HIV rapid test for members aged 16 years and above once a year. - HIV Elisa test (confirmatory test following a positive rapid test) for members aged 16 years and above. - Post Exposure Prophylaxis (PEP) for exposures associated with high risk of infection. Cover limited to occupational exposure.

9. Malaria Prophylaxis: - For members of all ages ( weight must be 20kg or more). Only applicable to health plans A, B & C.

10. Osteoporosis Screening: - Bone densitometry scan once every 2 years for members aged 40 years and above and members with family history of oesteoporosis. Only applicable to health plans A, B & C.

11. Prostate Cancer Screeing: - Prostate Specific Antigen (PSA) test for men aged 40 years and above once in two years.

12. Rabies Vaccine: - For members of all ages as and when needed. Only applicable to health plans A, B & C.

13. Tetanus Toxoid: - For members of all ages as and when needed. Only applicable to health plans A, B & C.

Notes: Benefits available only where service is given by Bomaid approved service providers. Managed care, clinicalprotocols and scheme rules apply. 100% payout by scheme. Bomaid tariffs strictly apply.

Value Add Benefits

EMERGENCY MEDICAL SERVICES

Bomaid has out-sourced this service to MRI Botswana. All Bomaid members can call MRI on 992 for emergency services throughout Botswana, Lesotho, Namibia, South Africa, Swaziland and Zimbabwe.

Services offered:

• Emergency medical assistance

• Upgrade transfer

• Inter hospital transfer

• Remote medical advice & information

• Downgrade transfer

• Medical repatriation

• Repatriation of mortal remains

• Emergency response to scene

• Escorted returns of minors • In hospital medical monitoring

• Pre hospital medical transportation

• Emergency transportation of medical products

• Liaison with next of kin

Dial OR +(267) 390 3066 for assistance.No 10%

copayment No VAT

FLUVACCINE


WAIVER OF PREMIUMS ON DEATH

The Bomaid Premium Waiver is an automatic benefit that ensures dependants remain Bomaid members for 12 months after the passing of the main member.

Bomaid provides additional value to the member by:

Value Add Benefits

Ensuring dependants do not have to make

monthly contributions themselves.

Providing financial freedom for the dependants to assist with their

circumstances.

Guaranteeing medical cover for all Bomaid

members with dependants.

Providing medical cover for dependants with no additional cost to the

main member.

BWP

Value Add Benefits

MATERNITY CARE PROGRAM

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:

Open discussions with a experienced midwife during

the various stages of the baby’s development .

Early identification of high risk pregnancy to enable

the family to access medical assistance where necessary.

Tailor made information on any medical conditions

in relation to the pregnancy.

A hamper with handy supplies for baby & mom

in the 3rd trimester.

Clinical support , education & advice from the 12th week of

pregnancy.

Ante natal classes by a designated service

provider.


A Healthplan SINGLE FAMILY

Overall Scheme Benefit Limit 274,145 290,772 1 In-Patient and Managed Care Benefits Overall Limit 236,250 252,000 (within the above, the following limits will apply i.e. 1.1, 1.2 and 1.3) 1.1 Dread Disease Cover * - strictly in accordance with the Bomaid list of approved Up to 236,250 Up to 252,000 dread diseases 1.2 Hospitalisation Maximum * (daily maximum room rate at agreed tariff **) 89,250 105,000 (within the above, the following sub-limits will apply)

1.2.1 Professionals fees 10,500 12,600

1.2.1.1 Doctors and other Professionals Up to 10,500 Up to 12,600

1.2.1.2 Laboratory fees excluding HIV monitoring Up to 10,500 Up to12,600

1.2.1.3 Radiology fees Up to 10,500 Up to 12,600

1.2.2 Psychiatry ^ (in-patient cover in a recognised psychiatric facility, includes professional fees) 15,750 15,750

1.2.3 Prosthesis ^ (external and internal) 6,300 6,825

1.2.4 Sub-acute care * (post admission step down - maximum 30 days) 14,280 14,280

1.2.5 Confinement * (the following sub-limits will apply)

1.2.5.1 Normal delivery hospitalisation fees (include forceps delivery and vacuum 3,675 3,675 extraction)

1.2.5.2 Birthing unit delivery global fee (by a registered unit/facility) 788 788

1.2.5.3 Caesarian section delivery hospitalisation fees 6,825 6,825

1.2.5.4 Normal delivery professional fees (includes post natal care) 3,660 3,660

1.2.5.5 Caesarian section professional fees (includes post natal care) 3,462 3,462

1.2.5.6 Anaesthetist fees (for Caesarian Section) 2,601 2,601

1.2.6 Neonatal hospitalisations (from 0 to 28 days of age) Up to 89,250 Up to 105,000

1.2.7 Laser refractive eye surgery * (referrals from approved Ophthalmologist 2,646 3,528 /Optometrist)

1.3 Managed Care Benefits *

1.3.1 Chemotherapy, radiation therapy and brachytherapy * (pre-authorisation required) 31,500 42,000

1.3.2 Renal dialysis for chronic renal failure * (pre-authorisation required) 31,500 42,000

1.3.3 Chronic medications * (supplied through the Managed Care Program in 10,500 12,600 accordance with the Bomaid list of approved chronic conditions) Registration with

Enjoy quality healthcare when you need it .

Bomaid, at the heart of health.


A

the Bomaid Managed Care Programme Required

1.3.4 Extended chronic medication benefit * ^ (cover on assessment) 5,250 6,300

1.3.5 ARV medications per beneficiary * (supplied through the Managed 12,600 Care Program) Registration with the Bomaid Managed Care Programme Required

** Where fixed fee arrangement has been entered into, those fees will apply ° Guaranteed ^ Cover on assessment *Pre-authorisation required

2 Medical/Surgical Out-Patient Overall Limit (Consultations, Medications, 17,790 24,568 Investigations and Procedures) (within the above overall limit , the following sub-limits will apply i.e. 2.1 to 2.5) 2.1 Consultations (GPs and Specialists. Includes ante-natal visits, examination and 3,829 5,064 two subsequent follow-up appointments of the newborn baby) 2.2 Antenatal Classes (by a contracted/approved service provider) 750 750 Registration with the Bombaby Program Required 2.3 Drugs/Prescribed Medicine Limit 3,491 4,935 2.3.1 Self medication (prescribed by pharmacist) 105 210

2.3.2 Doctor dispensed medicine (for acute cases only) 525 788

2.3.3 Pharmacy dispensed medicine (includes dental and ophthalmic prescribed 2,625 3,938 medications)

2.3.4 Chronic medications (refer to item 1.3.3) Up to 10,500 Up to 12,600

2.3.5 ARV medications per beneficiary (refer to item 1.3.5) Up to 12,600 Up to 12,600

2.4 Diagnostic/Investigative Procedure Limit 11,748 14,254

2.4.1 Laboratory investigations/tests excluding HIV monitoring 1,139 1,657 2.4.2 HIV laboratory monitoring per beneficiary (Registration with the Bomaid 3,500 Managed Care Programme Required)

2.4.3 X-Ray/Ultrasound scans (excludes 2 obstetric ultrasound scans for normal 1,034 1,447 pregnancy)

2.4.4 Obstetric ultrasound scans (maximum 2 scans in a normal pregnancy, 825 825 motivation andpre-authorisation required for high risk cases needing more than two scans)

2.4.4 MRI/CT scans * 5,250 6,825

2.4.5 Infertility diagnostic procedures No benefit No benefit 2.5 Medical/Surgical Procedure Limit 4,673 6,825

A Healthplan SINGLE FAMILY

2.5.1 Approved specialist major diagnostic procedures * 2,888 4,331

2.5.2 Minor medical procedures 893 1,181

2.5.3 Minor surgical procedures 893 1,181

2.5.4 Major procedures (ambulatory) Up to 4,673 Up to 6,825 * Pre-authorisation required ^ Cover on assessment

3 Dental and Oral Benefit Overall Limit 14,343 20,512

3.1 In-patient Dental Overall Limit * (the following sub-limits will apply) No benefit No benefit

3.1.1 Hospital fees No benefit No benefit

3.1.2 Dentist fees No benefit No benefit

3.1.3 Anaesthetist fees No benefit No benefit

3.2 Specialised Dental Treatment and Oral Surgery * ˜ 10,500 15,750

3.2.1 Simple maxillo-facial surgery: acute or chronic * Up to 10,500 Up to 15,750

3.2.2 Orthondontic treatment for members 25 years of age and below Up to 10,500 Up to 15,750 * ˜ (braces, retainers and related appliances)

3.3 Out-patient Dental Overall Limit 3,843 4,672 3.3.1 Basic dentistry (includes consultations, radiology, filling, extraction, cleaning, Up to 3,843 Up to 4,672 scaling and polishing, incision and drainage, root canal treatment)

3.3.2 Specialised dentistry * ˜ (includes crowns, bridges and dentures) and oral surgery Up to 3,843 Up to 4,672

3.3.3 Orthondontic treatment for members 26 years of age and above * ˜ (braces, Up to 3,843 Up to 4,672 retainers and related appliances) * Pre-authorisation required ˜ Refers to treatment every 2 years

4 Optical Benefit (2 year benefit cycle from anniversary of claiming per beneficiary) 4.1 Designated Service Providers (Managed Care Protocols Apply) 4.2 Non-Designated Service Providers (Managed Care Protocols Apply)

4.2.1 Consultation 135

4.2.2 Clear aquity single vision lenses (per lens) 200

4.2.3 Clear aquity bifocal lenses (per lens) 450

4.2.4 Clear aquity multifocal lenses (per lens) 600

SINGLE FAMILYSINGLE FAMILY

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A

4.2.5 Frame and/or any lens enhancements 600

4.2.6 Contact lenses (only claimable as an alternative to frame and lenses) 1,200 5 Appliances Overall Limit 5,250 6,195 5.1 General appliances 2,625 3,098

5.1.1 Medical appliances (including glucometers, nebulisers) 1,025 1,235

5.1.2 Surgical appliances (for non-permanent disability) ( to be recommended by 1,025 1,235 surgeon/orthopaedic surgeon) (includes knee/collar/chest/foot braces, crutches and walking frames) Pre-authorisation required

5.2 Wheel chairs, crutches and walking frames (for permanent disability) Up to 2,625 Up to 3,098

5.3 Hearing aid (prescription required) (maximum 1 pair of appliances Up to 5,250 Up to 6,195 per 2 year cycle)

5.4 CPAP machines, home oxygen, stoma products (CPAP machines and home Up to 5,250 Up to 6,195 oxygen cover subject to pre-authorisation and scheme protocols) 6 Allied Health Services Overall Limit 2,909 4,541 6.1 Rehabilitation Therapy (Medical Referral Needed for Sub-Limits 6.1.1 to 6.1.5)

6.1.1 Physiotherapy (motivational report needed for cases requiring more than 2,121 3,360 20 treatment sessions)

6.1.2 Occupational therapy 1,061 1,680

6.1.3 Speech therapy 1,061 1,680

6.1.4 Clinical psychology 1,061 1,680

6.1.5 Clinical dietetics (consultation only) - maximum 5 sessions 1,061 1,680 6.2 Alternative Treatment

6.2.1 Homeopathic treatment 788 1,181

6.2.2 Chiropractic treatment 788 1,181

6.2.3 Naturopathic treatment 788 1,181

6.2.4 Acupuncture treatment 788 1,181

6.2.5 Traditional healing (cover strictly limited to Ngope, Thobega and Mototwane) 788 1,181

6.2.6 Podiatry 788 1,181

A Healthplan SINGLE FAMILYSINGLE FAMILY

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A Healthplan

RIP

7 Safe Male Circumcision 1,600

Subject to Managed Care Protocols. Global fee includes related costs of pre-operative testing and post-operative care within one month of the procedure. 8 Severe Illness Benefit

(100% cash payout to the life assured on 1st diagnosis of any one of the pre-defined severe illnesses)

˘ Refers to main member and spouse ˘˘ Refers to child dependant 9 Executive Annual Medical Examination No benefit No benefit (Per Beneficiary - Limited to two family members)(Tests covered as per scheme plan) 10 Wellness Benefit

10.1 Annual health check for members aged 35 years and above 700 1,000 (includes initial GP consultation, general examination and follow up visit)

10.2 Screening and prevention benefits (Subject to defined scheme rules, managed care and clinical protocols. Refer to section on The Wellness Benefit . 11 Funeral Benefit

11.1 Member/ Spouse/ Parent 10, 000

11.2 Child dependant 14 - 21 years 10, 000



11.5 Child dependant under 1 year 1, 500

12 Funeral Benefit Top Up

The Bomaid Funeral Benefit Top Up is an optional benefit that allows the member to choose a cover that suits their needs. This cover is in addition to the basic funeral benefit the member already receives. This benefit can be purchased separately as an optional add-on to the existing benefit . T’s & C’s Apply 13 Hospital Cash Plan This benefit pays out cash to members per night of hospitalisation. The benefit is voluntary and is purchased separately as an optional add-on to the existing benefit . The cash payout , amongst other things, can be used to meet members’ expense that may arise as result of being hospitalised. T’s & C’s Apply

For more information

www.bomaid.co.bw

Bomaid

+267 3633100


www.bomaid.co.bw

Bomaid

+267 3633100


A

M M+1 M+2 M+3 M+4 Parent Both Parents

718 1,066 1,255 1,356 1,579 718 1,066

MEMBER

RATE

2018 Health Plan Subscription Rates

A Health Plan Subscription Rates

Co-payment Subscription Rates

A Plus Health Plan Subscription Rates

No Co-payment Subscription Rates

MEMBER

RATE


670 996 1,173 1,356 1,477 670 996

For A Health Plans, the Scheme may offer discounted rates to companies with 10 or more employees. For more information contact Client Services on 3633100.

For A Plus Health Plans, the Scheme may offer discounted rates to companies with 10 or more employees. For more information contact Client Services on 3633100.

Letter of motivation from the service provider/doctor

Detailed quotation

Name of the patient

Medical aid number

Doctor’s name and practice number

Hospital name and practice number

ICD10 codes (diagnoses codes)

Itemised procedure codes

Cost per procedure (add codes)

Date of admission

Pre-Authorisation Process

To process a pre-authorisation request , the Scheme requires the following:

B Healthplan SINGLE FAMILY

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Overall Scheme Benefit Limit 866,532 1,009,686 1 In-Patient and Managed Care Benefits Overall Limit 813,225 931,350 (within the above, the following limits will apply i.e. 1.1, 1.2 and 1.3) 1.1 Dread Disease Cover * - strictly in accordance with the Bomaid list of approved Up to 813,225 Up to 931,350 dread diseases 1.2 Hospitalisation Maximum * (daily maximum room rate at agreed tariff **) 393,225 511,350 (within the above, the following sub-limits will apply)

1.2.1 Professionals fees 175,500 168,000

1.2.1.1 Doctors and other Professionals Up to 175,500 Up to 168,000

1.2.1.2 Laboratory fees excluding HIV monitoring Up to 175,500 Up to 168,000

1.2.1.3 Radiology fees Up to 175,500 Up to 168,000

1.2.2 Psychiatry ^ (in-patient cover in a recognised psychiatric facility, includes 42,000 52,500 professional fees)

1.2.3 Prosthesis ^ (external and internal) 31,500 42,000

1.2.4 Sub-acute care * (post admission step down - maximum 30 days) 14,280 14,280

1.2.5 Confinement * (the following sub-limits will apply)

1.2.5.1 Normal delivery hospitalisation fees (include forceps delivery and vacuum 9,450 9,450 extraction)

1.2.5.2 Birthing unit delivery global fee (by a registered unit/facility) 2,100 2,100

1.2.5.3 Caesarian section delivery hospitalisation fees 13,650 13,650

1.2.5.4 Normal delivery professional fees (includes post natal care) 3,660 3,660

1.2.5.5 Caesarian section professional fees (includes post natal care) 3,462 3,462

1.2.5.6 Anaesthetist fees (for Caesarian Section) 2,601 2,601

1.2.6 Neonatal hospitalisations (from 0 to 28 days of age) Up to 393,225 Up to 511,350

1.2.7 Laser refractive eye surgery * (referrals from approved Ophthalmologist 4,725 5,775 /Optometrist)

1.3 Managed Care Benefits *

1.3.1 Chemotherapy, radiation therapy and brachytherapy * (pre-authorisation required) 136,500 157,500

1.3.2 Renal dialysis for chronic renal failure * (pre-authorisation required) 136,500 157,500

1.3.3 Chronic medications * (supplied through the Managed Care Program in 37,800 44,100 accordance with the Bomaid list of approved chronic conditions) Registration with


B

SINGLE FAMILY

the Bomaid Managed Care Programme Required

1.3.4 Extended chronic medication benefit * ^ (cover on assessment) 18,900 22,050

1.3.5 ARV medications per beneficiary * (supplied through the Managed 12,600 Care Program) Registration with the Bomaid Managed Care Programme Required

** Where fixed fee arrangement has been entered into, those fees will apply ° Guaranteed ^ Cover on assessment *Pre-authorisation required

2 Medical/Surgical Out-Patient Overall Limit (Consultations, Medications, 31,225 44,545 Investigations and Procedures) (within the above overall limit , the following sub-limits will apply i.e. 2.1 to 2.5) 2.1 Consultations (GPs and Specialists. Includes ante-natal visits, examination and 6,160 9,190 two subsequent follow-up appointments of the newborn baby) 2.2 Antenatal Classes (by a contracted/approved service provider) 750 750 Registration with the Bombaby Program Required 2.3 Drugs/Prescribed Medicine Limit 5,460 7,928 2.3.1 Self medication (prescribed by pharmacist) 210 315

2.3.2 Doctor dispensed medicine (for acute cases only) 788 1,181

2.3.3 Pharmacy dispensed medicine (includes dental and ophthalmic prescribed 3,938 5,906 medications)

2.3.4 Chronic medications (refer to item 1.3.3) Up to 37,800 Up to 44,100

2.3.5 ARV medications per beneficiary (refer to item 1.3.5) Up to 12,600 Up to 12,600

2.4 Diagnostic/Investigative Procedure Limit 24,328 24,028

2.4.1 Laboratory investigations/tests excluding HIV monitoring 2,100 3,150 2.4.2 HIV laboratory monitoring per beneficiary (Registration with the Bomaid 3,500 Managed Care Programme Required)

2.4.3 X-Ray/Ultrasound scans (excludes 2 obstetric ultrasound scans for normal 1,890 2,940 pregnancy)

2.4.4 Obstetric ultrasound scans (maximum 2 scans in a normal pregnancy, 825 825 motivation andpre-authorisation required for high risk cases needing more than two scans)

2.4.4 MRI/CT scans * 7,350 9,975

2.4.5 Infertility diagnostic procedures 2,625 3,938 2.5 Medical/Surgical Procedure Limit 8,400 12,600

2.5.1 Approved specialist major diagnostic procedures * 5,775 7,613

2.5.2 Minor medical procedures 1,313 1,969

2.5.3 Minor surgical procedures 1,313 1,969

2.5.4 Major procedures (ambulatory) Up to 8,400 Up to 12,600 * Pre-authorisation required ^ Cover on assessment

3 Dental and Oral Benefit Overall Limit 50,661 74,213

3.1 In-patient Dental Overall Limit * (the following sub-limits will apply) 23,100 27,300

3.1.1 Hospital fees 12,600 15,750

3.1.2 Dentist fees 5,775 6,300

3.1.3 Anaesthetist fees 4,725 5,250

3.2 Specialised Dental Treatment and Oral Surgery * ˜ 21,000 36,750

3.2.1 Simple maxillo-facial surgery: acute or chronic * Up to 21,000 Up to 36,750

3.2.2 Orthondontic treatment for members 25 years of age and below Up to 21,000 Up to 36,750 * ˜ (braces, retainers and related appliances)

3.3 Out-patient Dental Overall Limit 6,561 10,163 3.3.1 Basic dentistry (includes consultations, radiology, filling, extraction, cleaning, Up to 36,750 Up to 10,163 scaling and polishing, incision and drainage, root canal treatment)

3.3.2 Specialised dentistry * ˜ (includes crowns, bridges and dentures) and oral surgery Up to 36,750 Up to 10,163

3.3.3 Orthondontic treatment for members 26 years of age and above * ˜ (braces, Up to 36,750 Up to 10,163 retainers and related appliances) * Pre-authorisation required ˜ Refers to treatment every 2 years

4 Optical Benefit (2 year benefit cycle from anniversary of claiming per beneficiary) 4.1 Designated Service Providers (Managed Care Protocols Apply) 4.2 Non-Designated Service Providers (Managed Care Protocols Apply)

4.2.1 Consultation 135

4.2.2 Clear aquity single vision lenses (per lens) 500

4.2.3 Clear aquity bifocal lenses (per lens) 750

4.2.4 Clear aquity multifocal lenses (per lens) 1,200

SINGLE FAMILY

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B Healthplan


B

4.2.5 Frame and/or any lens enhancements 900

4.2.6 Contact lenses (only claimable as an alternative to frame and lenses) 2,500 5 Appliances Overall Limit 9,470 11,340 5.1 General appliances 4,725 5,670

5.1.1 Medical appliances (including glucometers, nebulisers) 1,235 1,419

5.1.2 Surgical appliances (for non-permanent disability) ( to be recommended by 1,235 1,419 surgeon/orthopaedic surgeon) (includes knee/collar/chest/foot braces, crutches and walking frames) Pre-authorisation required

5.2 Wheel chairs, crutches and walking frames (for permanent disability) Up to 4,725 Up to 5,670

5.3 Hearing aid (prescription required) (maximum 1 pair of appliances Up to 9,470 Up to 11,340 per 2 year cycle)

5.4 CPAP machines, home oxygen, stoma products (CPAP machines and home Up to 9,470 Up to 11,340 oxygen cover subject to pre-authorisation and scheme protocols) 6 Allied Health Services Overall Limit 7,881 11,294 6.1 Rehabilitation Therapy (Medical Referral Needed for Sub-Limits 6.1.1 to 6.1.5)

6.1.1 Physiotherapy (motivational report needed for cases requiring more than 6,831 9,194 20 treatment sessions)

6.1.2 Occupational therapy 3,416 5,222

6.1.3 Speech therapy 3,416 5,222

6.1.4 Clinical psychology 3,416 5,222

6.1.5 Clinical dietetics (consultation only) - maximum 5 sessions 3,416 5,222 6.2 Alternative Treatment

6.2.1 Homeopathic treatment 1,050 2,100

6.2.2 Chiropractic treatment 1,050 2,100

6.2.3 Naturopathic treatment 1,050 2,100

6.2.4 Acupuncture treatment 1,050 2,100

6.2.5 Traditional healing (cover strictly limited to Ngope, Thobega and Mototwane) 1,050 2,100

6.2.6 Podiatry 1,050 2,100

SINGLE FAMILY

RIP

SINGLE FAMILY

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B Healthplan

7 Safe Male Circumcision 1,600

Subject to Managed Care Protocols. Global fee includes related costs of pre-operative testing and post-operative care within one month of the procedure. 8 Severe Illness Benefit ˘20,000

(100% cash payout to the life assured on 1st diagnosis of any one of the ˘˘4,000 pre-defined severe illnesses)

˘ Refers to main member and spouse ˘˘ Refers to child dependant 9 Executive Annual Medical Examination No benefit No benefit (Per Beneficiary - Limited to two family members) (Tests covered as per scheme plan) 10 Wellness Benefit

10.1 Annual health check for members aged 35 years and above 700 1,000 (includes initial GP consultation, general examination and follow up visit)

10.2 Screening and prevention benefits (Subject to defined scheme rules, managed care and clinical protocols. Refer to section on The Wellness Benefit . 11 Funeral Benefit

11.1 Member/ Spouse/ Parent 10, 000




11.5 Child dependant under 1 year 1, 500

12 Funeral Benefit Top Up

The Bomaid Funeral Benefit Top Up is an optional benefit that allows the member to choose a cover that suits their needs. This cover is in addition to the basic funeral benefit the member already receives. This benefit can be purchased separately as an optional add-on to the existing benefit . T’s & C’s Apply 13 Hospital Cash Plan This benefit pays out cash to members per night of hospitalisation. The benefit is voluntary and is purchased separately as an optional add-on to the existing benefit . The cash payout , amongst other things, can be used to meet members’ expense that may arise as result of being hospitalised. T’s & C’s Apply


www.bomaid.co.bw

Bomaid

+267 3633100


www.bomaid.co.bw

Bomaid

+267 3633100


B

B Health Plan Subscription Rates

Co-payment Subscription Rate

B Plus Health Plan Subscription Rates

No Co-payment Subscription Rates

For B Health Plans, the Scheme may offer discounted rates to companies with 10 or more employees. For more information contact Client Services on 3633100.

For B Plus Health Plans, the Scheme may offer discounted rates to companies with 10 or more employees. For more information contact Client Services on 3633100.

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Dread Disease Benefit

This ONCE OFF 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:

1 Coronary Artery Disease Dread disease benefit will ONLY be considered where the coronary arteries are severely narrowed resulting in a need for coronary artery bypass surgery or open heart surgery.

2 Valvular Heart Disease Dread disease benefit will ONLY be considered where there is medical proof of severe cardiac vulvular dysfunction needing a surgical intervention such as valve repair or replacement .

3 Heart Failure Dread disease benefit will ONLY be considered where there is medical proof that the member requires major surgical intervention.

4 Cerebro Vascular Accident / Stroke Dread disease benefit will ONLY be considered where there is medical proof that the member requires major surgical intervention such as craniotomy. This cover also includes rehabilitation therapy at an agreed daily or global tariff for a period not exceeding 36 days. 5 End Stage Renal Failure Dread disease benefit will ONLY be considered where there is medical proof that the member requires kidney transplant . The benefit covers only the recipient Bomaid member.

6 Leukaemia Dread disease benefit will ONLY be considered where there is medical proof that the member requires bone marrow transplant . The benefit covers only the recipient Bomaid member. Any other related treatments fall within the Dread Disease Cover.

7 Cancer/Malignant Neoplasm Dread disease benefit will ONLY be considered where there is medical proof that the member has a malignant type of cancer and requires a major surgical intervention.

8 Cerebral Aneurysm (Grade iii to v) Dread disease benefit will ONLY be considered where there is medical proof that the aneurysm is of grade III or above and that the member requires a major surgical intervention such as craniotomy or ligation of blood vessels. The benefit also covers rehabilitation therapy at an agreed daily or global tariff for a period not exceeding 36 days. 9 Organ Transplant The benefit covers transplantation of the following conditions only: Heart , Bone Marrow and Kidney. Cover is only for the recipient Bomaid member.

2018 Health Plan Subscription Rates


1,164 1,802 2,091 2,358 2,613 1,164 1,802

MEMBER

RATE

MEMBER

RATE


1,089 1,685 1,955 2,204 2,442 1,089 1,685

Letter of motivation from the service provider/doctor

Detailed quotation

Name of the patient

Medical aid number

Doctor’s name and practice number

Hospital name and practice number

ICD10 codes (diagnoses codes)

Itemised procedure codes

Cost per procedure (add codes)

Date of admission

Pre-Authorisation Process

To process a pre-authorisation request , the Scheme requires the following:


1 Allergic Rhinitis (only if associated with asthma) 16 Gout

2 Arthritis 17 HIV/AIDS

3 Ankylosing Spondylitis 18 Hypercholesterolaemia

4 Asthma 19 Hypertension

5 Benign prostate Hypertrophy 20 Inflammatory Bowel Disease

6 Bipolar Disorder 21 Migraine (excludes acute attacks)

7 Chronic Anxiety 22 Multiple Sclerosis

8 Chronic Depression 23 Osteopoenia

9 Chronic Bronchitis 24 Osteoporosis

10 Chronic Heart Diseases 25 Parkinson’s Disease

11 Chronic Renal Failure 26 Peptic Ulcer Disease

12 Chronic Obstructive Pulmonary Disease 27 Psoriasis

13 Diabetes 28 Schizophrenia

14 Epilepsy 29 Systemic Lupus Erythematosus

15 Glaucoma 30 Thyroid Dysfunction

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:

Managed Care Program

HIV/AIDS is a chronic condition managed under the HIV/AIDS Assistance Program.

ASSISTANCE PROVIDED BY BOMAID IS AS FOLLOWS:

• Cover for antiretroviral drugs

• Cover for laboratory monitoring tests

• Psychosocial support (counselling) including adherence counselling

• Cover for hospitalisation related to HIV/AIDS and/or opportunistic conditions

• Regular monitoring, evaluation and reporting

• Each individual enrolled on the program will be assisted with up to P12,600.00 per annum for ARV Medications and up to P3,500 per annum for laboratory tests.

• ARV Medications are provided through the Bomaid Managed Care Program only.

• Hospitalisation cover for HIV/AIDS related conditions is only available to members enrolled on the program.

HIV/AIDS Assistance Program

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Additional Notes:

1. In-patient and Managed Care Benefits:

n Pre-authorisation is required for all cases. Scheme and/or managed care protocols will be applied. n 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. n 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 . n No cover for ARVs supplied outside the Bomaid designated pharmacies.

2. Medical/Surgical Out-patient Benefit:

n No cover for infertility treatment procedures.

3. Pharmaceutical Benefit Management

n Generic reference pricing (GRP) will apply to all schemes except Scheme C. n 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 . n Members will not pay the 10% co-payment should they opt to take the available generic medicines. n 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 .

4. Dental Benefit:

n Maximum 2 preventative treatments per beneficiary per annum (e.g. cleaning, scaling and polishing). n Re-treatment (e.g. filling) of a tooth within one year will be subjected to managed care and clinical protocols. n Cover excludes: orthognatic (jaw correction) surgery, professionally applied fluoride, dental bleaching and implants. n 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. n A two-year benefit cycle applies for specialised dentistry (including orthodontic treatment , crowns, bridges and dentures).

5. Optical Benefit:

n Reduced levels of member co-payments for services obtained from designated service providers. n A two year benefit cycle applies (excludes consultations).

6. Appliances Benefit:

n One wheel chair per beneficiary over a 3 year cycle. n One pair of hearing aids per beneficiary over a 2 year cycle.

7. Allied Health Services Benefit:

n Occupational therapy, speech therapy and clinical psychology benefits exclude therapy for social, educational and developmental problems. n Alternative treatment claim payments will only be made to members and not service providers.

8. Safe Male Circumcision:

n Cover includes pre-operative consultation/counselling, physical examination, HIV test and post- operative care within 1 month of operation.

9. Wellness Benefit:

n Annual health check applicable to members aged 35 years and above in health plans A, C and C only. n Bone densitometry scan, tetanus toxoid, rabies vaccine and malaria prophylaxis applicable to health plans A, B and C only. n No pre-authorisation required for screening and prevention benefits. n 100% payout of the scheme tariffs. No copayment . No VAT.

10. Executive Annual Medical Examination:

n 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 SINGLEMEMBER’S LIMIT.

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www.bomaid.co.bw [email protected] bomaid

Healthier, Happier Lives.

Head Office Gaborone

Maun Branch

Francistown Branch

Botswana Medical Aid Plot 50638 Fairgrounds

+267 363 3100/101

+267 318 4230/152

P . O . Box 632 Gaborone, Botswana

Botswana Medical Aid Plot 270/271 Tsheko Tsheko Road (Old Delta Medical)Prime Health Medical Centre

+267 686 4577

+267 686 4455

Botswana Medical Aid Plot 21931/21932, Tebo House Ground Floor

+267 241 0316

+267 241 0341

P . O . Box 3328 Francistown, Botswana

Contacts

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