Benefits Guide & Rates. At the heart of health. 1

Transcription

1 Beefits Guide & Rates 1

2 Cotets 2018 Rates & Beefits Guide Value Add Beefits 5-9 A Health Pla A Health Pla Subscriptio Rates 16 B Health Pla B Health Pla Subscriptio Rates 22 Dread Disease Beefit 23 Maaged Care Program 24 HIV/AIDS Assistace Program 25 Additioal Notes Family health matters 2 Bomaid Healthpla Guide

3 Value Add Beefits Bomaid for healthier, happier lives. Through diverse health plas, Bomaid offers a comprehesive set of solutios that cater for the health ad welless eeds of your life. SEVERE ILLNESS BENEFIT This beefit is desiged to provide a 100% cash payout to the life assured o 1st diagosis of ay of the pre-defied severe illesses regardless of the actual medical expeses icurred. The cash payout ca be used amog other thigs to: a) Assist members with additioal medical costs which might be above the allocated scheme limits b) Pay for alterative care or rehabilitatio therapies ot covered by the scheme c) Fud lifestyle chages that might be required followig diagosis ad/or treatmet of a severe illess. The followig severe illesses are covered uder this beefit: Cacer A A Healthpla Coroary Artery Disease Heart Attack AS Healthpla IS IS Healthpla B B Healthpla B Healthpla Kidey Failure (Chroic) Major Orga Trasplat (Kidey, Lug, Liver, Heart, Pacreas) Health Plas Stroke The beefit has a termiatio age of 65 years. T s & C s Apply AS AS Healthpla C C Healthpla 4 Bomaid Healthpla Guide

4 Value Add Beefits Value Add Beefits WELLNESS BENEFIT This beefit is desiged to help members with prevetio ad early detectio of certai illesses/medical coditios. The beefit covers the followig: 1. Aual Health Check: - For members ages 35 years ad above oce a year. Oly applicable to health plas A, B & C. Icludes cosultatio ad examiatio. EMERGENCY MEDICAL SERVICES Bomaid has out-sourced this service to MRI Botswaa. All Bomaid members ca call MRI o 992 for emergecy services throughout Botswaa, Lesotho, Namibia, South Africa, Swazilad ad Zimbabwe. Services offered: FLU VACCINE 2. Breast Cacer Screeig: - Mammogram for wome aged years oce i two years. 3. Cervical Cacer Screeig: - Pap smear test for wome aged years oce i two years. 4. Cardiovascular Disease Screeig: - Blood cholesterol test for members aged 35 years ad above oce a year. 5. Diabetes Screeig: - Blood glucose test for members aged 35 years ad above oce a year. 6. Flu Vaccie: - Vacciatio oce a year for members aged 10 years ad below, members aged 65 years ad above ad members with certai chroic coditios (e.g. chroic respiratory diseases, chroic pulmoary obstructive diseases, chroic heart diseases, chroic kidey diseases, diabetes, HIV/AIDS etc.) 7. Glaucoma Screeig: - Screeig test oce a year for members aged 40 years ad above, members with family history of glaucoma ad members with diabetes. 8. HIV AIDS Screeig: - HIV rapid test for members aged 16 years ad above oce a year. - HIV Elisa test (cofirmatory test followig a positive rapid test) for members aged 16 years ad above. - Post Exposure Prophylaxis (PEP) for exposures associated with high risk of ifectio. Cover limited to occupatioal exposure. 9. Malaria Prophylaxis: - For members of all ages ( weight must be 20kg or more). Oly applicable to health plas A, B & C. 10. Osteoporosis Screeig: - Boe desitometry sca oce every 2 years for members aged 40 years ad above ad members with family history of oesteoporosis. Oly applicable to health plas A, B & C. 11. Prostate Cacer Screeig: - Prostate Specific Atige (PSA) test for me aged 40 years ad above oce i two years. 12. Rabies Vaccie: - For members of all ages as ad whe eeded. Oly applicable to health plas A, B & C. 13. Tetaus Toxoid: - For members of all ages as ad whe eeded. Oly applicable to health plas A, B & C. Emergecy medical assistace Emergecy respose to scee Pre hospital medical trasportatio Emergecy trasportatio of medical products Liaiso with ext of ki Iter hospital trasfer Upgrade trasfer Remote medical advice & iformatio Dowgrade trasfer Medical repatriatio Repatriatio of mortal remais Escorted returs of miors I hospital medical moitorig Notes: Beefits available oly where service is give by Bomaid approved service providers. Maaged care, cliical protocols ad scheme rules apply. 100% payout by scheme. Bomaid tariffs strictly apply. No 10% copaymet No VAT Dial OR +(267) for assistace. 6 Bomaid Healthpla Guide

5 Value Add Beefits Value Add Beefits WAIVER OF PREMIUMS ON DEATH The Bomaid Premium Waiver is a automatic beefit that esures depedats remai Bomaid members for 12 moths after the passig of the mai member. Bomaid provides additioal value to the member by: MATERNITY CARE PROGRAM Through Bombaby, we share with the expectat family the excitemet ad experiece brought about by the ew life we are waitig for. The program offers: Cliical support, educatio & advice from the 12 th week of pregacy. Ate atal classes by a desigated service provider. Providig fiacial freedom for the depedats to assist with their circumstaces. Esurig depedats do ot have to make mothly cotributios themselves. Ope discussios with a experieced midwife durig the various stages of the baby s developmet. Early idetificatio of high risk pregacy to eable the family to access medical assistace where ecessary. BWP Providig medical cover for depedats with o additioal cost to the mai member. Guarateeig medical cover for all Bomaid members with depedats. Tailor made iformatio o ay medical coditios i relatio to the pregacy. A hamper with hady supplies for baby & mom i the 3 rd trimester. 8 Bomaid Healthpla Guide

6 A Healthpla A Overall Scheme Beefit Limit 274, ,772 1 I-Patiet ad Maaged Care Beefits Overall Limit 236, ,000 (withi the above, the followig limits will apply i.e. 1.1, 1.2 ad 1.3) 1.1 Dread Disease Cover * - strictly i accordace with the Bomaid list of approved Up to 236,250 Up to 252,000 dread diseases 1.2 Hospitalisatio Maximum * (daily maximum room rate at agreed tariff **) 89, ,000 (withi the above, the followig sub-limits will apply) Professioals fees 10,500 12, Doctors ad other Professioals Up to 10,500 Up to 12, Laboratory fees excludig HIV moitorig Up to 10,500 Up to12, Radiology fees Up to 10,500 Up to 12, Psychiatry ^ (i-patiet cover i a recogised psychiatric facility, icludes professioal fees) 15,750 15, Prosthesis ^ (exteral ad iteral) 6,300 6, Sub-acute care * (post admissio step dow - maximum 30 days) 14,280 14, Cofiemet * (the followig sub-limits will apply) Normal delivery hospitalisatio fees (iclude forceps delivery ad vacuum 3,675 3,675 extractio) Birthig uit delivery global fee (by a registered uit/facility) Caesaria sectio delivery hospitalisatio fees 6,825 6, Normal delivery professioal fees (icludes post atal care) 3,660 3, Caesaria sectio professioal fees (icludes post atal care) 3,462 3, Aaesthetist fees (for Caesaria Sectio) 2,601 2, Neoatal hospitalisatios (from 0 to 28 days of age) Up to 89,250 Up to 105, Laser refractive eye surgery * (referrals from approved Ophthalmologist 2,646 3,528 /Optometrist) Ejoy quality healthcare whe you eed it. Bomaid, at the heart of health. 1.3 Maaged Care Beefits * Chemotherapy, radiatio therapy ad brachytherapy * (pre-authorisatio required) 31,500 42, Real dialysis for chroic real failure * (pre-authorisatio required) 31,500 42, Chroic medicatios * (supplied through the Maaged Care Program i 10,500 12,600 accordace with the Bomaid list of approved chroic coditios) Registratio with 10 Bomaid Healthpla Guide

7 A Healthpla A the Bomaid Maaged Care Programme Required Exteded chroic medicatio beefit * ^ (cover o assessmet) 5,250 6, ARV medicatios per beeficiary * (supplied through the Maaged 12,600 Care Program) Registratio with the Bomaid Maaged Care Programme Required ** Where fixed fee arragemet has bee etered ito, those fees will apply Guarateed ^ Cover o assessmet *Pre-authorisatio required 2 Medical/Surgical Out-Patiet Overall Limit (Cosultatios, Medicatios, 17,790 24,568 Ivestigatios ad Procedures) (withi the above overall limit, the followig sub-limits will apply i.e. 2.1 to 2.5) 2.1 Cosultatios (GPs ad Specialists. Icludes ate-atal visits, examiatio ad 3,829 5,064 two subsequet follow-up appoitmets of the ewbor baby) 2.2 Ateatal Classes (by a cotracted/approved service provider) Registratio with the Bombaby Program Required 2.3 Drugs/Prescribed Medicie Limit 3,491 4, Self medicatio (prescribed by pharmacist) Doctor dispesed medicie (for acute cases oly) Pharmacy dispesed medicie (icludes detal ad ophthalmic prescribed 2,625 3,938 medicatios) Chroic medicatios (refer to item 1.3.3) Up to 10,500 Up to 12, ARV medicatios per beeficiary (refer to item 1.3.5) Up to 12,600 Up to 12, Diagostic/Ivestigative Procedure Limit 11,748 14, Laboratory ivestigatios/tests excludig HIV moitorig 1,139 1, HIV laboratory moitorig per beeficiary (Registratio with the Bomaid 3,500 Maaged Care Programme Required) X-Ray/Ultrasoud scas (excludes 2 obstetric ultrasoud scas for ormal 1,034 1,447 pregacy) Obstetric ultrasoud scas (maximum 2 scas i a ormal pregacy, motivatio adpre-authorisatio required for high risk cases eedig more tha two scas) MRI/CT scas * 5,250 6, Ifertility diagostic procedures No beefit No beefit 2.5 Medical/Surgical Procedure Limit 4,673 6, Approved specialist major diagostic procedures * 2,888 4, Mior medical procedures 893 1, Mior surgical procedures 893 1, Major procedures (ambulatory) Up to 4,673 Up to 6,825 * Pre-authorisatio required ^ Cover o assessmet 3 Detal ad Oral Beefit Overall Limit 14,343 20, I-patiet Detal Overall Limit * (the followig sub-limits will apply) No beefit No beefit Hospital fees No beefit No beefit Detist fees No beefit No beefit Aaesthetist fees No beefit No beefit 3.2 Specialised Detal Treatmet ad Oral Surgery * 10,500 15, Simple maxillo-facial surgery: acute or chroic * Up to 10,500 Up to 15, Orthodotic treatmet for members 25 years of age ad below Up to 10,500 Up to 15,750 * (braces, retaiers ad related appliaces) 3.3 Out-patiet Detal Overall Limit 3,843 4, Basic detistry (icludes cosultatios, radiology, fillig, extractio, cleaig, Up to 3,843 Up to 4,672 scalig ad polishig, icisio ad draiage, root caal treatmet) Specialised detistry * (icludes crows, bridges ad detures) ad oral surgery Up to 3,843 Up to 4, Orthodotic treatmet for members 26 years of age ad above * (braces, Up to 3,843 Up to 4,672 retaiers ad related appliaces) * Pre-authorisatio required Refers to treatmet every 2 years 4 Optical Beefit (2 year beefit cycle from aiversary of claimig per beeficiary) 4.1 Desigated Service Providers (Maaged Care Protocols Apply) 4.2 No-Desigated Service Providers (Maaged Care Protocols Apply) Cosultatio Clear aquity sigle visio leses (per les) Clear aquity bifocal leses (per les) Clear aquity multifocal leses (per les) Bomaid Healthpla Guide

8 A Healthpla A Frame ad/or ay les ehacemets Cotact leses (oly claimable as a alterative to frame ad leses) 1,200 5 Appliaces Overall Limit 5,250 6, Geeral appliaces 2,625 3, Medical appliaces (icludig glucometers, ebulisers) 1,025 1, Surgical appliaces (for o-permaet disability) ( to be recommeded by 1,025 1,235 surgeo/orthopaedic surgeo) (icludes kee/collar/chest/foot braces, crutches ad walkig frames) Pre-authorisatio required 5.2 Wheel chairs, crutches ad walkig frames (for permaet disability) Up to 2,625 Up to 3, Hearig aid (prescriptio required) (maximum 1 pair of appliaces Up to 5,250 Up to 6,195 per 2 year cycle) 5.4 CPAP machies, home oxyge, stoma products (CPAP machies ad home Up to 5,250 Up to 6,195 oxyge cover subject to pre-authorisatio ad scheme protocols) 6 Allied Health Services Overall Limit 2,909 4, Rehabilitatio Therapy (Medical Referral Needed for Sub-Limits to 6.1.5) Physiotherapy (motivatioal report eeded for cases requirig more tha 2,121 3, treatmet sessios) Occupatioal therapy 1,061 1, Speech therapy 1,061 1, Cliical psychology 1,061 1, Cliical dietetics (cosultatio oly) - maximum 5 sessios 1,061 1, Alterative Treatmet Homeopathic treatmet 788 1, Chiropractic treatmet 788 1, Naturopathic treatmet 788 1, Acupucture treatmet 788 1, Traditioal healig (cover strictly limited to Ngope, Thobega ad Mototwae) 788 1, Podiatry 788 1,181 7 Safe Male Circumcisio 1,600 Subject to Maaged Care Protocols. Global fee icludes related costs of pre-operative testig ad post-operative care withi oe moth of the procedure. 8 Severe Illess Beefit (100% cash payout to the life assured o 1 st diagosis of ay oe of the pre-defied severe illesses) Refers to mai member ad spouse Refers to child depedat 9 Executive Aual Medical Examiatio No beefit No beefit (Per Beeficiary - Limited to two family members)(tests covered as per scheme pla) 10 Welless Beefit 10.1 Aual health check for members aged 35 years ad above 700 1,000 (icludes iitial GP cosultatio, geeral examiatio ad follow up visit) 10.2 Screeig ad prevetio beefits (Subject to defied scheme rules, maaged care ad cliical protocols. Refer to sectio o The Welless Beefit. RIP 11 Fueral Beefit 11.1 Member/ Spouse/ Paret 10, Child depedat years 10, Child depedat 6-13 years 5, Child depedat 1-5 years 2, Child depedat uder 1 year 1, Fueral Beefit Top Up The Bomaid Fueral Beefit Top Up is a optioal beefit that allows the member to choose a cover that suits their eeds. This cover is i additio to the basic fueral beefit the member already receives. This beefit ca be purchased separately as a optioal add-o to the existig beefit. T s & C s Apply 13 Hospital Cash Pla This beefit pays out cash to members per ight of hospitalisatio. The beefit is volutary ad is purchased separately as a optioal add-o to the existig beefit. The cash payout, amogst other thigs, ca be used to meet members expese that may arise as result of beig hospitalised. T s & C s Apply For more iformatio Bomaid For more iformatio Bomaid Bomaid Healthpla Guide

9 2018 Health Pla Subscriptio Rates B Healthpla B A Health Pla Subscriptio Rates Co-paymet Subscriptio Rates Overall Scheme Beefit Limit 866,532 1,009,686 1 I-Patiet ad Maaged Care Beefits Overall Limit 813, ,350 (withi the above, the followig limits will apply i.e. 1.1, 1.2 ad 1.3) MEMBER RATE M M+1 M+2 M+3 M+4 Paret Both Parets ,173 1,356 1, Dread Disease Cover * - strictly i accordace with the Bomaid list of approved Up to 813,225 Up to 931,350 dread diseases 1.2 Hospitalisatio Maximum * (daily maximum room rate at agreed tariff **) 393, ,350 (withi the above, the followig sub-limits will apply) For A Health Plas, the Scheme may offer discouted rates to compaies with 10 or more employees. For more iformatio cotact Cliet Services o A Plus Health Pla Subscriptio Rates No Co-paymet Subscriptio Rates MEMBER RATE M M+1 M+2 M+3 M+4 Paret Both Parets 718 1,066 1,255 1,356 1, ,066 For A Plus Health Plas, the Scheme may offer discouted rates to compaies with 10 or more employees. For more iformatio cotact Cliet Services o Pre-Authorisatio Process To process a pre-authorisatio request, the Scheme requires the followig: Professioals fees 175, , Doctors ad other Professioals Up to 175,500 Up to 168, Laboratory fees excludig HIV moitorig Up to 175,500 Up to 168, Radiology fees Up to 175,500 Up to 168, Psychiatry ^ (i-patiet cover i a recogised psychiatric facility, icludes 42,000 52,500 professioal fees) Prosthesis ^ (exteral ad iteral) 31,500 42, Sub-acute care * (post admissio step dow - maximum 30 days) 14,280 14, Cofiemet * (the followig sub-limits will apply) Normal delivery hospitalisatio fees (iclude forceps delivery ad vacuum 9,450 9,450 extractio) Birthig uit delivery global fee (by a registered uit/facility) 2,100 2, Caesaria sectio delivery hospitalisatio fees 13,650 13,650 Letter of motivatio from the service provider/doctor Detailed quotatio Name of the patiet Medical aid umber Doctor s ame ad practice umber Hospital ame ad practice umber ICD10 codes (diagoses codes) Itemised procedure codes Cost per procedure (add codes) Date of admissio Normal delivery professioal fees (icludes post atal care) 3,660 3, Caesaria sectio professioal fees (icludes post atal care) 3,462 3, Aaesthetist fees (for Caesaria Sectio) 2,601 2, Neoatal hospitalisatios (from 0 to 28 days of age) Up to 393,225 Up to 511, Laser refractive eye surgery * (referrals from approved Ophthalmologist 4,725 5,775 /Optometrist) 1.3 Maaged Care Beefits * Chemotherapy, radiatio therapy ad brachytherapy * (pre-authorisatio required) 136, , Real dialysis for chroic real failure * (pre-authorisatio required) 136, , Chroic medicatios * (supplied through the Maaged Care Program i 37,800 44,100 accordace with the Bomaid list of approved chroic coditios) Registratio with 16 Bomaid Healthpla Guide

10 B Healthpla B the Bomaid Maaged Care Programme Required Exteded chroic medicatio beefit * ^ (cover o assessmet) 18,900 22, ARV medicatios per beeficiary * (supplied through the Maaged 12,600 Care Program) Registratio with the Bomaid Maaged Care Programme Required ** Where fixed fee arragemet has bee etered ito, those fees will apply Guarateed ^ Cover o assessmet *Pre-authorisatio required 2 Medical/Surgical Out-Patiet Overall Limit (Cosultatios, Medicatios, 31,225 44,545 Ivestigatios ad Procedures) (withi the above overall limit, the followig sub-limits will apply i.e. 2.1 to 2.5) 2.1 Cosultatios (GPs ad Specialists. Icludes ate-atal visits, examiatio ad 6,160 9,190 two subsequet follow-up appoitmets of the ewbor baby) 2.2 Ateatal Classes (by a cotracted/approved service provider) Registratio with the Bombaby Program Required 2.3 Drugs/Prescribed Medicie Limit 5,460 7, Self medicatio (prescribed by pharmacist) Doctor dispesed medicie (for acute cases oly) 788 1, Pharmacy dispesed medicie (icludes detal ad ophthalmic prescribed 3,938 5,906 medicatios) Chroic medicatios (refer to item 1.3.3) Up to 37,800 Up to 44, ARV medicatios per beeficiary (refer to item 1.3.5) Up to 12,600 Up to 12, Diagostic/Ivestigative Procedure Limit 24,328 24, Laboratory ivestigatios/tests excludig HIV moitorig 2,100 3, HIV laboratory moitorig per beeficiary (Registratio with the Bomaid 3,500 Maaged Care Programme Required) X-Ray/Ultrasoud scas (excludes 2 obstetric ultrasoud scas for ormal 1,890 2,940 pregacy) Obstetric ultrasoud scas (maximum 2 scas i a ormal pregacy, motivatio adpre-authorisatio required for high risk cases eedig more tha two scas) MRI/CT scas * 7,350 9, Ifertility diagostic procedures 2,625 3, Medical/Surgical Procedure Limit 8,400 12, Approved specialist major diagostic procedures * 5,775 7, Mior medical procedures 1,313 1, Mior surgical procedures 1,313 1, Major procedures (ambulatory) Up to 8,400 Up to 12,600 * Pre-authorisatio required ^ Cover o assessmet 3 Detal ad Oral Beefit Overall Limit 50,661 74, I-patiet Detal Overall Limit * (the followig sub-limits will apply) 23,100 27, Hospital fees 12,600 15, Detist fees 5,775 6, Aaesthetist fees 4,725 5, Specialised Detal Treatmet ad Oral Surgery * 21,000 36, Simple maxillo-facial surgery: acute or chroic * Up to 21,000 Up to 36, Orthodotic treatmet for members 25 years of age ad below Up to 21,000 Up to 36,750 * (braces, retaiers ad related appliaces) 3.3 Out-patiet Detal Overall Limit 6,561 10, Basic detistry (icludes cosultatios, radiology, fillig, extractio, cleaig, Up to 36,750 Up to 10,163 scalig ad polishig, icisio ad draiage, root caal treatmet) Specialised detistry * (icludes crows, bridges ad detures) ad oral surgery Up to 36,750 Up to 10, Orthodotic treatmet for members 26 years of age ad above * (braces, Up to 36,750 Up to 10,163 retaiers ad related appliaces) * Pre-authorisatio required Refers to treatmet every 2 years 4 Optical Beefit (2 year beefit cycle from aiversary of claimig per beeficiary) 4.1 Desigated Service Providers (Maaged Care Protocols Apply) 4.2 No-Desigated Service Providers (Maaged Care Protocols Apply) Cosultatio Clear aquity sigle visio leses (per les) Clear aquity bifocal leses (per les) Clear aquity multifocal leses (per les) 1, Bomaid Healthpla Guide

11 B Healthpla B Frame ad/or ay les ehacemets Cotact leses (oly claimable as a alterative to frame ad leses) 2,500 5 Appliaces Overall Limit 9,470 11, Geeral appliaces 4,725 5, Medical appliaces (icludig glucometers, ebulisers) 1,235 1, Surgical appliaces (for o-permaet disability) ( to be recommeded by 1,235 1,419 surgeo/orthopaedic surgeo) (icludes kee/collar/chest/foot braces, crutches ad walkig frames) Pre-authorisatio required 5.2 Wheel chairs, crutches ad walkig frames (for permaet disability) Up to 4,725 Up to 5, Hearig aid (prescriptio required) (maximum 1 pair of appliaces Up to 9,470 Up to 11,340 per 2 year cycle) 5.4 CPAP machies, home oxyge, stoma products (CPAP machies ad home Up to 9,470 Up to 11,340 oxyge cover subject to pre-authorisatio ad scheme protocols) 6 Allied Health Services Overall Limit 7,881 11, Rehabilitatio Therapy (Medical Referral Needed for Sub-Limits to 6.1.5) Physiotherapy (motivatioal report eeded for cases requirig more tha 6,831 9, treatmet sessios) Occupatioal therapy 3,416 5, Speech therapy 3,416 5, Cliical psychology 3,416 5, Cliical dietetics (cosultatio oly) - maximum 5 sessios 3,416 5, Alterative Treatmet Homeopathic treatmet 1,050 2, Chiropractic treatmet 1,050 2, Naturopathic treatmet 1,050 2, Acupucture treatmet 1,050 2, Traditioal healig (cover strictly limited to Ngope, Thobega ad Mototwae) 1,050 2, Podiatry 1,050 2,100 7 Safe Male Circumcisio 1,600 Subject to Maaged Care Protocols. Global fee icludes related costs of pre-operative testig ad post-operative care withi oe moth of the procedure. 8 Severe Illess Beefit 20,000 (100% cash payout to the life assured o 1 st diagosis of ay oe of the 4,000 pre-defied severe illesses) Refers to mai member ad spouse Refers to child depedat 9 Executive Aual Medical Examiatio No beefit No beefit (Per Beeficiary - Limited to two family members) (Tests covered as per scheme pla) 10 Welless Beefit 10.1 Aual health check for members aged 35 years ad above 700 1,000 (icludes iitial GP cosultatio, geeral examiatio ad follow up visit) 10.2 Screeig ad prevetio beefits (Subject to defied scheme rules, maaged care ad cliical protocols. Refer to sectio o The Welless Beefit. RIP 11 Fueral Beefit 11.1 Member/ Spouse/ Paret 10, Child depedat years 10, Child depedat 6-13 years 5, Child depedat 1-5 years 2, Child depedat uder 1 year 1, Fueral Beefit Top Up The Bomaid Fueral Beefit Top Up is a optioal beefit that allows the member to choose a cover that suits their eeds. This cover is i additio to the basic fueral beefit the member already receives. This beefit ca be purchased separately as a optioal add-o to the existig beefit. T s & C s Apply 13 Hospital Cash Pla This beefit pays out cash to members per ight of hospitalisatio. The beefit is volutary ad is purchased separately as a optioal add-o to the existig beefit. The cash payout, amogst other thigs, ca be used to meet members expese that may arise as result of beig hospitalised. T s & C s Apply For more iformatio Bomaid For more iformatio Bomaid Bomaid Healthpla Guide

12 2018 Health Pla Subscriptio Rates Dread Disease Beefit B Health Pla Subscriptio Rates Co-paymet Subscriptio Rate MEMBER RATE For B Health Plas, the Scheme may offer discouted rates to compaies with 10 or more employees. For more iformatio cotact Cliet Services o B Plus Health Pla Subscriptio Rates No Co-paymet Subscriptio Rates MEMBER RATE For B Plus Health Plas, the Scheme may offer discouted rates to compaies with 10 or more employees. For more iformatio cotact Cliet Services o Pre-Authorisatio Process M M+1 M+2 M+3 M+4 Paret Both Parets 1,089 1,685 1,955 2,204 2,442 1,089 1,685 M M+1 M+2 M+3 M+4 Paret Both Parets 1,164 1,802 2,091 2,358 2,613 1,164 1,802 To process a pre-authorisatio request, the Scheme requires the followig: Letter of motivatio from the service provider/doctor Detailed quotatio Name of the patiet Hospital ame ad practice umber ICD10 codes (diagoses codes) Itemised procedure codes This ONCE OFF IN A LIFETIME COVER is offered i terms of rule 15 (1) of the Society rules ad i accordace with the levels defied below. Dread diseases covered uder this beefit are as outlied below: 1 Coroary Artery Disease Dread disease beefit will ONLY be cosidered where the coroary arteries are severely arrowed resultig i a eed for coroary artery bypass surgery or ope heart surgery. 2 Valvular Heart Disease Dread disease beefit will ONLY be cosidered where there is medical proof of severe cardiac vulvular dysfuctio eedig a surgical itervetio such as valve repair or replacemet. 3 Heart Failure Dread disease beefit will ONLY be cosidered where there is medical proof that the member requires major surgical itervetio. 4 Cerebro Vascular Accidet / Stroke Dread disease beefit will ONLY be cosidered where there is medical proof that the member requires major surgical itervetio such as craiotomy. This cover also icludes rehabilitatio therapy at a agreed daily or global tariff for a period ot exceedig 36 days. 5 Ed Stage Real Failure Dread disease beefit will ONLY be cosidered where there is medical proof that the member requires kidey trasplat. The beefit covers oly the recipiet Bomaid member. 6 Leukaemia Dread disease beefit will ONLY be cosidered where there is medical proof that the member requires boe marrow trasplat. The beefit covers oly the recipiet Bomaid member. Ay other related treatmets fall withi the Dread Disease Cover. 7 Cacer/Maligat Neoplasm Dread disease beefit will ONLY be cosidered where there is medical proof that the member has a maligat type of cacer ad requires a major surgical itervetio. Medical aid umber Doctor s ame ad practice umber Cost per procedure (add codes) Date of admissio 8 Cerebral Aeurysm (Grade iii to v) Dread disease beefit will ONLY be cosidered where there is medical proof that the aeurysm is of grade III or above ad that the member requires a major surgical itervetio such as craiotomy or ligatio of blood vessels. The beefit also covers rehabilitatio therapy at a agreed daily or global tariff for a period ot exceedig 36 days. 9 Orga Trasplat The beefit covers trasplatatio of the followig coditios oly: Heart, Boe Marrow ad Kidey. Cover is oly for the recipiet Bomaid member. 22 Bomaid Healthpla Guide

13 Maaged Care Program HIV/AIDS Assistace Program The program assists members with maagemet of chroic coditios ad icludes both beefit maagemet ad cliical advice. The followig coditios are covered uder the program: HIV/AIDS is a chroic coditio maaged uder the HIV/AIDS Assistace Program. ASSISTANCE PROVIDED BY BOMAID IS AS FOLLOWS: 1 Allergic Rhiitis (oly if associated with asthma) 16 Gout 2 Arthritis 17 HIV/AIDS 3 Akylosig Spodylitis 18 Hypercholesterolaemia 4 Asthma 19 Hypertesio 5 Beig prostate Hypertrophy 20 Iflammatory Bowel Disease 6 Bipolar Disorder 21 Migraie (excludes acute attacks) 7 Chroic Axiety 22 Multiple Sclerosis 8 Chroic Depressio 23 Osteopoeia 9 Chroic Brochitis 24 Osteoporosis 10 Chroic Heart Diseases 25 Parkiso s Disease 11 Chroic Real Failure 26 Peptic Ulcer Disease Cover for atiretroviral drugs Cover for laboratory moitorig tests Psychosocial support (cousellig) icludig adherece cousellig Cover for hospitalisatio related to HIV/AIDS ad/or opportuistic coditios Regular moitorig, evaluatio ad reportig Each idividual erolled o the program will be assisted with up to P12, per aum for ARV Medicatios ad up to P3,500 per aum for laboratory tests. ARV Medicatios are provided through the Bomaid Maaged Care Program oly. Hospitalisatio cover for HIV/AIDS related coditios is oly available to members erolled o the program. 12 Chroic Obstructive Pulmoary Disease 27 Psoriasis 13 Diabetes 28 Schizophreia 14 Epilepsy 29 Systemic Lupus Erythematosus 15 Glaucoma 30 Thyroid Dysfuctio 24 Bomaid Healthpla Guide

14 Additioal Notes: 1. I-patiet ad Maaged Care Beefits: Pre-authorisatio is required for all cases. Scheme ad/or maaged care protocols will be applied. Post-admissio step dow cover icludes sub-acute care, hospice, private ursig ad physical rehabilitatio for approved cliical coditios. Excludes old age homes ad frail care. Chroic medicies will be covered uder the chroic medicatio beefit oly if supplied through the Bomaid desigated pharmacies. Ay chroic medicies supplied outside the desigated pharmacies will be covered uder the pharmacy beefit. No cover for ARVs supplied outside the Bomaid desigated pharmacies. 2. Medical/Surgical Out-patiet Beefit: No cover for ifertility treatmet procedures. 3. Pharmaceutical Beefit Maagemet Geeric referece pricig (GRP) will apply to all schemes except Scheme C. Uder the GRP, a brad-ame medicie that has a geeric equivalet registered i Botswaa ad available at the poit of service will be reimbursed up to the tariff of the geeric equivalet. Members will ot pay the 10% co-paymet should they opt to take the available geeric medicies. Members will pay the differece betwee the tariff of the brad-ame medicie ad the geeric equivalet should they opt to take the brad-ame medicie while there is a available geeric equivalet. 8. Safe Male Circumcisio: Cover icludes pre-operative cosultatio/cousellig, physical examiatio, HIV test ad postoperative care withi 1 moth of operatio. 9. Welless Beefit: Aual health check applicable to members aged 35 years ad above i health plas A, C ad C oly. Boe desitometry sca, tetaus toxoid, rabies vaccie ad malaria prophylaxis applicable to health plas A, B ad C oly. No pre-authorisatio required for screeig ad prevetio beefits. 100% payout of the scheme tariffs. No copaymet. No VAT. 10. Executive Aual Medical Examiatio: Covers pricipal member plus oe (1) adult depedat per year. Cover icludes physicia cosultatio, physical examiatio icludig cacer screeig, blood work up, ECG, ad o-ivasive radiology. Excludes blood tumor markers ad mammograms. IN ALL BENEFIT CATEGORIES, ANY ONE MEMBER CANNOT CLAIM IN EXCESS OF THE MEMBER S LIMIT. 4. Detal Beefit: Maximum 2 prevetative treatmets per beeficiary per aum (e.g. cleaig, scalig ad polishig). Re-treatmet (e.g. fillig) of a tooth withi oe year will be subjected to maaged care ad cliical protocols. Cover excludes: orthogatic (jaw correctio) surgery, professioally applied fluoride, detal bleachig ad implats. Pre-authorisatio is required for all i-hospital detal procedures as well as specialised detistry (icludig orthodotic treatmet, crows, bridges ad detures). Pre-authorisatio is ot required for surgical procedures doe uder local aaesthesia i out-patiet rooms. A two-year beefit cycle applies for specialised detistry (icludig orthodotic treatmet, crows, bridges ad detures). 5. Optical Beefit: Reduced levels of member co-paymets for services obtaied from desigated service providers. A two year beefit cycle applies (excludes cosultatios). 6. Appliaces Beefit: Oe wheel chair per beeficiary over a 3 year cycle. Oe pair of hearig aids per beeficiary over a 2 year cycle. 7. Allied Health Services Beefit: Occupatioal therapy, speech therapy ad cliical psychology beefits exclude therapy for social, educatioal ad developmetal problems. Alterative treatmet claim paymets will oly be made to members ad ot service providers. 26 Bomaid Healthpla Guide

15 Cotacts Head Office Gaboroe Fracistow Brach Botswaa Medical Aid Plot Fairgrouds /101 Botswaa Medical Aid Plot 21931/21932, Tebo House Groud Floor / P. O. Box 632 Gaboroe, Botswaa P. O. Box 3328 Fracistow, Botswaa Mau Brach Botswaa Medical Aid Plot 270/271 Tsheko Tsheko Road (Old Delta Medical) Prime Health Medical Cetre Healthier, Happier Lives. bomaid