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Corporate Schemes A, B, C

   
         
 
Benefits Schedules
Scheme A
Scheme B
Scheme C
Single
Family
Single
Family
Single
Family
OVERALL SCHEME LIMIT BENEFIT
261,090
276,926
825,269
961,606
1,286,782
1,700,000
1.0 IN-PATIENT/CHRONIC OVERALL LIMIT
225,000
240,000
774,500
887,000
1,190,000
1,415,000
(within the above, the following limits apply i.e 1.1,1.2 and 1.3)
1.1 Dreaded Disease cover - strictly in accordance with the BOMaid approved list and pre-authorization.
up to limit 1.0
up to limit 1.0
up to limit 1.0
up to limit 1.0
up to limit 1.0
up to limit 1.0
1.1.1 Daily maximum Room Rate** (at agreed tariff)
1.2 Chronic/Professional/ Hospitalization maximum*
85,000
100,000
374,500
487,000
690,000
915,000
(within the above, the following sub-limits will apply) same as 1.1.1
1.2.1 Acute post trauma maxillo-facial surgery^ limit
10,000
15,000
20,000
35,000
30,000
45,000
1.2.2 Chronic medication (SUPPLIED THROUGH BOMAID DISPENSARY in accordance with BOMaid approved program)
10,000
12,000
36,000
42,000
48,000
64,000
1.2.3 Chemotherapy/Radiotherapy
20,000
20,000
80,000
80,000
90,000
110,000
1.2.4 Renal dialysis
20,000
20,000
90,000
90,000
90,000
120,000
1.2.5 Psychiatric^ – Inpatient – in a recognized psychiatric facility
10,000
10,000
30,000
40,000
40,000
55,000
1.2.6 Internal Prosthesis^
5,000
5,000
20,000
30,000
25,000
40,000
1.2.7 Normal delivery hospitalization fees (include forceps delivery and vacuum extraction)
3,000
3,000
7,500
7,500
7,500
7,500
1.2.8 Birthing unit delivery global fee (by a registered unit/facility)
750
750
2,000
2,000
2,000
2,000
1.2.9 Caesarian delivery - hospitalization fees
5,000
5,000
11,000
11,000
12,000
12,000
Professional fees
1.2.10 Confinement (Each sub limit subject to tariff limit)
2,628
2,628
3,500
3,500
4,000
4,000
Normal delivery Professional fee (includes post natal care)
2,189
2,189
2,189
2,189
2,189
2,189
Or
Caesarian section Professional fee (includes post natal care)
2,070
2,070
2,070
2,070
2,228
2,228
Anesthetist fees (for Caesarian Section)
500
500
500
500
900
900
1.2.11 Procedures
5,000
7,000
20,000
30,000
25,000
40,000
1.2.12 Laboratory excluding HIV monitoring
1,000
1,200
5,000
6,500
6,000
8,000
1.2.13 Radiology
3,000
3,500
10,000
15,000
15,000
20,000
1.2.14 Post admission step down (max. 30 days)
13,600
13,600
13,600
13,600
13,600
13,600
1.2.15 Neonates hospitalizations
60,000
100,000
60,000
100,000
120,000
120,000
** Where fixed fee arrangement has been entered into, those fees will apply.
-
-
-
-
-
-
° Guaranteed ^ Cover on assessment *Pre-authorization required
-
-
-
-
-
-
2.0 MEDICAL/SURGICAL OUTPATIENT OVERALL LIMIT
13,990
20,446
26,814
39,471
39,712
55,750
(Consult./Drugs/Investigations/Procedures) Within the above overall limit, the following sub limits will apply i.e. 2.1 to 2.5
-
-
-
-
-
-
2.1 Consultation* (GP/Specialist) limit. (Include ante-natal visits, exam of newborn baby and two subsequent follow ups)
2,070
2,690
3,614
5,421
4,743
6,238
2.2 Drugs/Prescribed medicine limit
3,325
4,700
5,200
7,550
8,380
11,850
2.2.1 Self Medication (Prescribed by Pharmacist)
100
200
200
300
300
450
2.2.2 Doctors dispensing (acute)
500
750
750
1,125
1,427
2,200
2.2.3 Pharmacy dispensed medicine (include Dental & Ophthalmic prescribed)
2,500
3,750
3,750
5,625
6,653
9,200
2.2.4 Medication (through BOMaid dispensary)
up to 2.2
up to 2.2
up to 2.2
up to 2.2
up to 2.2
up to 2.2
2.3 See 1.0 above
-
-
-
-
-
-
2.4 Diagnostic/Investigation limit
4,370
6,556
10,500
15,000
15,415
20,901
2.4.1 Laboratory investigations/tests excluding HIV monitoring
585
1,078
1,500
2,500
2,665
3,775
2.4.2 X-ray/Ultrasound (exclude two pre-authorized obstetric ultra-sounds)**
985
1,378
1,800
2,800
2,950
4,425
2.4.2.1 Obstetric ultrasound (max. 2 pre-authorised)
400
400
400
400
400
400
2.4.3 MRI/CT Scan
3,000
4,500
5,000
7,500
6,250
9,376
2.4.4 Infertility diagnostic procedures
Nil
Nil
2,500
3,750
4,000
5,400
2.5 Medical/Surgical Procedure Limit
4,450
6,500
8,000
12,000
11,174
16,761
2.5.1 Approved specialist major diagnostic**
2,750
4,125
5,500
7,250
6,750
10,125
2.5.2 Minor medical procedure
850
1,125
1,250
1,875
2,212
3,318
2.5.3 Minor surgical procedure
850
1,125
1,250
1,875
2,212
3,318
2.5.4 Major procedure (ambulatory)
up to 2.5
up to 2.5
up to 2.5
up to 2.5
up to 2.5
up to 2.5
*Refers to rates at agreed tariffs **Pre-authorization required
-
-
-
-
-
-
3.0 DENTAL OVERALL LIMIT
2,160
3,035
4,749
8,179
6,620
12,000
3.1 Basic Dentistry Sub-limit (Consultation, radiology, filling, tooth extraction,cleaning and scaling, incision and drainage,root canal treatment)
1,000
2,200
1,509
3,319
1,620
4,500
3.2 Specialized Dentistry‑˜ (includes crowns, bridges, dentures and diagnosis)
up to limit 3.0
up to limit 3.0
3,240
4,860
5,000
7,500
3.3 Orthodontic/Maxillo-facial/Oral Surgery (subject to case management) treatment include implants
up to limit 3.0
up to limit 3.0
up to limit 3.0
up to limit 3.0
up to limit 3.0
up to limit 3.0
˜ Refers to treatment every two years.
-
-
-
-
-
-
4.0 OPTICAL OVERALL LIMIT (over two years)
Full cover in accordance with set limits through BOMaid Designated Service Providers.
4.1 BOMaid Designated Service Providers




4.2 Non-BOMaid Designated Service Providers
Guaranteed eye care benefit
which includes consultation(s),
one pair of clear aquity single vision lenses and a frame.
-Guaranteed eye care benefit which includes consultation(s),
one pair of clear aquity single vision lenses or one pair of clear
aquity bifocal lenses or one pair of clear aquity multifocal lenses to
the value of bifocal lenses and a frame

4.2.1 Consultation
100
-
100
-
100
-

4.2.2 Clear aquity single vision lenses (per lens)
165
  
165
  
165
  

4.2.3 Clear aquity bifocal lenses (per lens)
-
-
375
-
375
-

4.2.4 Clear aquity multifocal lenses (per lens)
-
  
to the value of bifocal lenses
to the value of bifocal lenses
4.3 Frame and/or any lens enhancements
150
  
550
  
850
-
4.4 Contact lenses (NB: Benefit ONLY available as an alternative to 4.1, 4.2 and 4.3)
450
-
1050
-
1350
-
4.5 Laser refractive eye surgery (referrals from BOMaid approved opthalmologist/ optometrist with a prescription of - 5.00
dioptre and below) NB: Use of this benefit nullifies any optical benefit entitlement for the subsequent five years of
membership.
1680
2520
3000
4500
4500
5500
5.0 APPLIANCES OVERALL LIMIT
2,500
2,950
4,500
5,400
5,000
6,500
5.1 Surgical appliances {recommended by surgeon/orthopedic surgeon (for non permanent disability) e.g knee/collar/chest /foot braces, crutches and walking frames} Pre-authorization required
100
150
200
250
500
750
5.2 Wheel chairs, crutches and walking frames (for permanently physically challenged)
up to limit 5.0
up to limit 5.0
up to limit 5.0
up to limit 5.0
up to limit 5.0
up to limit 5.0
5.3 Hearing aid (prescription is required)
up to limit 5.0
up to limit 5.0
up to limit 5.0
up to limit 5.0
up to limit 5.0
up to limit 5.0
5.4 Medical appliances e.g glucometer and nebuliser (recommended by Physician/ Pediatrician)
500
700
700
875
1,000
1,125
6.0 REHABILITATION THERAPY OVERALL LIMIT
2,020
3,200
3,200
8,756
8,904
13,356
(excluding appliances) Medical referral is required for all as well as pre-assessment for cover of 6.2 to 6.5)
-
-
-
-
-
-
6.1 Physiotherapy
Motivational report is needed for assessment of cases requiring more than 20 treatment sessions.
1,010
1,600
3,253
4,973
4,452
6,678
6.2 Occupational Therapy
1,010
1,600
3,253
4,973
4,452
6,678
6.3 Speech Therapy
1,010
1,600
3,253
4,973
4,452
6,678
6.4 Clinical psychology
1,010
1,600
3,253
4,973
4,452
6,678
6.5 Clinical Dietician (consultation only) maximum 5 session
1,010
1,600
3,253
4,973
4,452
6,678
7.0 ALTERNATIVE TREATMENT OVERALL LIMIT
750
1,125
1,000
2,000
1,500
3,000
7.1 Homeopathic treatment
750
1,125
1,000
2,000
1,500
3,000
7.2 Chiropractic treatment
750
1,125
1,000
2,000
1,500
3,000
7.3 Naturopathic treatment
750
1,125
1,000
2,000
1,500
3,000
7.4 Acupuncture treatment
750
1,125
1,000
2,000
1,500
3,000
7.5 Traditional Healing - (cover strictly limited to for Ngope, Thobega and Mototwane)
750
1,125
1,000
2,000
1,500
3,000
8.0 FUNERAL BENEFIT
3,000
-
3,000
-
3,000
-
8.1 Member /Spouse/parent ˘
-
8,000
-
8,000
-
8,000
8.2 Dependant over 5 years ˘˘
-
3,000
-
3,000
-
3,000
8.3 Dependant up to 5 years ˘˘
-
1,500
-
1,500
-
1,500
˘ Refers to parent dependant
˘˘ Refers to registered member dependant
--
-
--
-
--
-
9.0 MEDICAL EMERGENCY EVACUATION
Full Cover through MRI
Full Cover through MRI
Full Cover through MRI
Full Cover through MRI
Full Cover through MRI
Full Cover through MRI

1. HIV/AIDS COVER IN ACCORDANCE WITH THE SBF PROGRAM
2. MEMBER'S ATTENTION IS SPECIFICALLY DRAWN TO RULE 15 (20): “In all benefit categories any one family member cannot claim in excess of the single member's limit”.

  
         
Contact Details: P. O. Box 632. Gaborone. Botswana
Tel: +267 3184210, +267 3633101, Fascimile: +267 3184230,
Francistown Branch Tel: +267 241 0316, Fax: +267 241 0341
Email: bomaid@bomaid.co.bw
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