Manage my Health Plan

Find out information on how to make payments, submit a claim, process a preauthorisation request and determine your health plan’s subscription rates.


Update your membership details:
Membership Information Update Form

Add a new dependant, register your child or new-born baby:
Application for Additional Dependant Form

Payments can be made monthly, quarterly or semi-annually.

Payment methods can include:

For more information on how to pay download our subscription payments & arrears notice.

Preauthorisation is the process during which a service provider seeks confirmation and authorisation from the fund with regards to the availability of a member’s medical aid cover for a specific treatment, service or procedure.

To process a preauthorisation request, the fund requires the following:
  • 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

Upon receipt of all the required documents, the member/provider will be notified of the status of the member’s benefits and their associated coverage.

How it works

Preauthorisation requests can be submitted through any of the Bomaid offices listed below:
  • Gaborone Life Private Hospital : Bomaid Office Contact Details: +267 3685678
  • Lenmed Bokamoso Private Hospital : Bomaid Office Contact Details: +267 3694132
  • Bomaid Head Office:+267 3633282 : casemanagement@bomaid.co.bw
  • Bomaid Johannesburg – MSO +27 (11) 259 5115 / 5000 : bomaid@mso.co.za

Claim Reimbursement Process

What is a claim?

It is financial reimbursement made to you or your service provider for medical services rendered. You may claim for reimbursement if you paid for your own treatment. Payment will be made in line with scheme rules and applicable tariffs. Submit your claims within 4 months of the treatment or service.

You have a choice of where to obtain medical services (locally, regionally and internationally) in line with your health plan.

If you are not sure whether a treatment or service is covered by your health plan, please contact our call centre on +267 3633100 for clarification.

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.
Member claims

To claim a refund, you will need to submit the following:

  • Member needs to fill out and submit a completed Member Claim Form
  • All original invoices and receipts for the treatment or service. You can post all invoices and receipts to: P O Box 632, Gaborone, Botswana (original documents) or email to claimsubmissions@bomaid.co.bw (scanned copies of original documents, but the originals are still needed for payment, so these can be posted)

Please note:

  • Bomaid does not reimburse for VAT
  • The amount refunded is subject to the limitations of the member’s benefits under their scheme
  • Refunds may not exceed the published Bomaid service provider tariffs
  • Original invoices and receipts should be submitted for a claim to be paid
How it Works

 

how-it-works

PLEASE NOTE THAT FOR YOUR CLAIM TO BE PAID: ORIGIONAL INVOICES & RECEIPTS SHOULD BE SUBMITTED
Doctor/ Hospital/ Lab/ Pharmacy Claims

These claims are submitted by the service provider, but it is the member’s responsibility to ensure the details are correct. Payments will be deducted from your Bomaid account, and are subject to the same conditions as member claims.

View our list of registered doctors and service providers who claim directly on your behalf.

Subscription Rates

All medical scheme subscriptions are payable in advance, by the 7th of the month. For detailed rates information on your scheme, use our rates calculator, or call +267 (36) 33 100.

Rates Calculator