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Apply for Advance Medication Supply

Requirements

  • Completed advance supply request form 
  • Advance subscription payments or letter from Employer confirming employment status and assurance that subscriptions will be paid for the months of advance supply
  • Copy of prescription (NB-only authorized chronic medication will be covered)
  • Copy of itinerary/proof of travel/ confirmation letter that member resides outside the country

    Request for extended supply of medication

    This form is used to apply for a sufficient supply of medicine for a maximum of three months. Please note: Should you leave your Medical Scheme within the authorization period for extended medicine, you will be billed for the remaining months. 

    How to complete this application 

  • One application form is to be completed per patient
  • Please attach copy of your air ticket, itinerary or letter from employer confirming travel dates.
  • Please complete ALL sections of the application in full. Incomplete applications will result in administrative delays.
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One file only.
2 GB limit.
Allowed types: pdf, doc, docx.
One file only.
2 GB limit.
Allowed types: pdf, doc, docx.
One file only.
2 GB limit.
Allowed types: pdf, doc, docx, .

CLIENT INFORMATION CONSENT

In terms of the Data Protection Act, Bomaid is obligated to obtain the customer’s consent to acquire and process customer information. To provide performance of a contract to which the customer is a party, Bomaid might have to share the customer’s personal and sensitive data with authorized third parties such as service providers and consultants for processing. Our comprehensive privacy notice is available on our website.

I authorize Bomaid or any Bomaid contracted outsourced providers to collect, process, and request my personal and sensitive data from any healthcare service provider or person who has attended to me or my dependants in the past or who will attend to us in the future or who may be in possession of information about us, including our health status, treatment received or anticipated as well as any other relevant health information for any purpose directly related to our membership or which is authorized in terms of the Medical Schemes Act, the Scheme Rules, or any other legislation, also after the death or termination of membership of any of us.

I authorize Bomaid to deal with my dependants and me electronically and treat electronic communication (such as email, telephone, Bomaid’s digital App) as being the same as written authority and confirmation. I agree further that, where we choose to use electronic methods to transact with Bomaid, we will carry the risk of such use.

Bomaid may use my information for the purpose of marketing (including direct marketing) of its suite of products, benefits, and any other financial or non-financial services offered by itself and its subsidiaries.

I have the right to see any information that Bomaid holds about me, and to have my details removed.

I provide the consent of my own free will without any undue influence from any person whatsoever, and I understand that I can withdraw my consent in writing at any time. The grounds for withdrawing consent should be legitimate, reasonable, and compelling.

The Fund may send your personal information to service providers outside Botswana for the storage or further processing on behalf of Bomaid. Bomaid will ensure to adhere to the provisions of the Data Protection Act before such transborder transfer of your personal information.