Faqs

About Bomaid Scheme

A medical scheme is a not-for-profit entity governed by NBIFIRA. Members of a medical scheme pay contributions every month and in return, receive medical cover according to the rules of the scheme. Member contributions are paid directly into a pool of funds. Any money not paid out in claims and administration fees remains in this pool. Overseen by a Board of Trustees, this pool of funds belongs solely to the members.

Joining Bomaid is easy. Simply ‘Join Us’ or dial 3633100 for more assistance and to get a quote.

The registered scheme rules can be found in the ‘Find a document’ tab, titled ‘Book of Rules’

Benefits & Limits

A benefit is a pool of funds in a medical scheme 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.

Membership

Yes, you can join Bomaid as an individual. Individuals who wish to subscribe directly with the Society in their individual capacity, can do so through the Comprehensive and Customised Schemes.

There is no minimum to the number of people that can be registered on a company. Your company can continuously add new members as it continues to grow.

Dependants are allowed under their parents health plans up to the age of twenty-one. This is the age when children grow into adulthood and may be joining the world of work and therefore becoming independent. However if your children are still attending school or going for tertiary education you are required to provide us with a letter certifying that indeed they are students. They will then continue as dependants until they are 25 years of age, at which point they are terminated automatically. Alternatively they can move to any of the Comprehensive and Customised Health Plans on their own. The above condition is in exception of medically challenged dependants whose cases are assessed individually.

An employee retiring from a Constituent Body on pension (normal retirement age 65 years) or who terminates his employment on account of early retirement due to ill health (age 55) and who has at the date of retirement paid subscriptions to Bomaid for a minimum period of ten years shall have the option at the date of retirement of applying for pension membership.

Yes, it is possible to apply for medical cover for your parents. All you have to do is complete application forms for them. Note that all members joining us from the age 50 and above are subject to medical exam, except for those who join out Outpatient Scheme (Scheme A Standard).

Yes, continuation of membership is available for members in your situation. However, it is important to notify us of your new particulars as soon as possible as well as to ensure that you subscription payments do not elapse.

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.

  • It comes as a benefit through HIV voluntary testing . (The screening is provided for by Bomaid on an annual basis at no cost)
  • Once tested positive for HIV,  your doctor registers you into the HIV Assistance Program.
  • You will then be inducted into the program to understand how it operates
  • You will be assisted with cover for laboratory monitoring tests which are to be done only at designated service providers
  • You will be supplied with medications by designated service providers
  • You will be engaged regularly to find out how you are doing
  • You will be provided with counselling as needed

 

Having a Baby

Once you are 12 weeks pregnant you can contact us on 3633101 or email bombaby@bomaid.co.bw to register for our Maternity Program called Bombaby. You will also need to contact us to authorise your admission for the delivery of your baby. Your cover for delivery is subject to your health plan’s benefits and rules.

For your baby not to be subjected to the three month waiting period, you need to register your child within 48hours 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.

Claiming

In medical aid terms, a claim is a formal request from a member or a service provider to a medical aid company asking for payment/ reimbursement based on the services received or rendered in terms of the benefits and limits provided. A claim is usually paid up to the scheme tariff.

You can send in your claims in one of these ways:

  • Scan and email your claim to claimssubmission@bomaid.co.bw
  • You can also post to Botswana Medical Aid Society, P.O Box 632, Gaborone
  • Or drop the claim at our offices through our Reception

NB: We  still need the original invoice and the receipt for your refund to be completed.

FOREIGN CLAIM PROCESSING:

The following documentation will be required to process all claims incurred outside Botswana:

  1. Proof of travel (stamped passport showing departure and return dates)
  2. Medical report and or referral letter
  3. Original detailed invoice with member and service provider signature (NB: All documents to be written in or translated to English. Only translations from sworn translator will be accepted)
  4. Proof of payment: original or scanned receipt / proof of bank transaction / sped point slip
  5. All members undergoing major or planned hospital procedures outside Botswana will be required to notify the scheme of such prior to the procedure or treatment
  6. Reimbursement amounts will be in accordance with the exchange rate applicable and Scheme Rules and Tariffs.

 

You must send us your claim within four (4) months from the date you saw your healthcare professional.

Bomaid cover for clinical psychology as well as other types of therapy allowed on your benefits is limited to treatments motivated by medical conditions. The medical reports are used to facilitate your claim assessment.

In order for you to be reimbursed you need to present original receipts and invoices from the service provider and within four months form the treatment date.

Value added tax is a consumption tax that every citizen has to pay. Your medical aid is however, extremely concerned with the effect of VAT on the long-term delivery cost of general healthcare. This in particular in the context of our country’s mandate that advocates for all Botswana to have access to good quality health facilities. In the meantime Bomaid’s management believes that some assistance is required in one way or another. The society is confident that with ongoing discussions between the medical aid industry and the Ministry responsible for the policy, there may be some positive outcomes in the near future.

Your Cover

Bomaid covers each procedure according to the benefits available on your health plan. If you need to be hospitalised, you must call us to confirm your admission to hospital and get authorisation. We will explain how your procedure will be covered. If the procedure / treatment falls within your outpatient benefits, you can receive the service from your health service provider, pay the 10% co-payment and VAT, and your service provider will send the rest of the bill to Bomaid to claim.

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.

Find a healthcare professional we have an agreement with.

Lost Card Assistance

Simply request a new card by contacting us 3633101 or email us at bomaid@bomaid.co.bw. While you wait for your card you can use a membership certificate as proof of membership. Note that for lost card, you will need to pay P20 to replace it. However, if your card has been stolen, you can bring a police affidavit to get a card from our offices at no charge.

Traveling Outside Botswana

Yes, we have a travel cover for members who are in the Scheme C Health Plan. The Travel Cover under Scheme C 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 Scheme C Health Plan.

Alternatively, members who travel outside Botswana and are not Scheme C members, will be subject to Bomaid’s ‘Foreign Claim Processing’ requirements as indicated under ‘Claim Reimbursement’

 

 

Bomaid will guarantee payment for in-patient hospitalisation in South Africa once the hospital guarantee request is received as per our arrangements with the hospital. The hospital must communicate with Bomaid at the time of admission of the patient. Members have to ensure before leaving, that their membership is up to date, that is, subscription payments, benefit availability so that they have a clear indication of what their liability to the hospital will be depending on the hospital charges. We do have a Group of contracted hospitals in South Africa which Bomaid pays directly on your behalf.

 

Getting Documents

You can get proof of membership by contacting us on 3633101 or email us on bomaid@bomaid.co.bw

Bomaid Complaints Process

Bomaid undertakes to resolve all customer complaints within 14 working days of receipt of a complaint together with all supporting documents from our member.

Talk to the Client Service Manager

Lodge your complaint through the Client Service Manager. Complaints can be in writing, in person or via telephone. Our officer will give you a reference number which serves to document when complaint was lodged and details of complaint. Kindly furnish the officer with supporting documents for your complaint. If you are not satisfied with the feedback or there been no response from the Officer within 14 working days contact The Chief Operations Officer.

Complaints done in writing ought to have the following information;

  • Names and membership number
  • Details of the complaint
  • Supporting documents

Chief Operations Officer

In case you are not satisfied with feedback from your customer service officer / contact centre agent and the Client Services Manager, escalate the issue with the Chief Operations Officer. The Chief Operations Officer will further investigate and prepare a response to the member within 7working days. If the complaint is not resolved to the member’s satisfaction raise the issue with the Chief Executive Officer.

Chief Executive Officer

The Chief Executive will review the solution offered to the member by the Sales & Client Service Manager and Fund Administration Manager and advise if reasonable action has been taken or not. A response is prepared and member informed of the outcome. The Chief Executive Officer will prepare a report for the office of the Principal Officer. If the member is still not satisfied they may approach the offices of the Non-Banking Financial Institutions Regulating Authority.

Non-Banking Financial Institutions Regulatory Authority

Communications Department

Private Bag 00314,
3rd floor Exponential Building
Plot 54351 New CBD,
Off PG Matante Road, Gaborone

Tel: +267 310 2595, 3686100
Fax: +267 3102376, 3102353
Email: info@nbfira.org.bw