2017

Benefit Booklet

International Student Health Plan

No 10% Co-payment

No waiting period

No VAT

Value Add Benefits 4-5

ISS Health Plan Benefit 6

Managed Care Program 9

Additional Notes 10

04

05

09

Contents

| 2 | IS HEALTH PLAN BENEFIT 2017 | |3

P455per month

ONLY! To register for the International Student Health Plan, members are required to provide proof of schooling i.e letter of admission.!

This benefit is designed to provide a 100% cash payout to the life assured on 1st diagnosis of any of the pre-defined severe illnesses regardless of the actual medical expenses incurred.

The cash payout can be used among other things to: a) Assist members with additional medical costs which might be above the allocated

scheme limitsb) Pay for alternative care or rehabilitation therapies not covered by the schemec) Fund lifestyle changes that might be required following diagnosis and/or treatment

of a severe illness.

The following severe illnesses are covered under this benefit:

Emergency Medical Services

Bomaid has out-sourced this service from MRI Botswana (MRI). All Bomaid members can call MRI on 992 for emergency services throughout Botswana, Lesotho, Namibia, South Africa, Swaziland and Zimbabwe.

Services offered:

• Cancer• Coronary Artery Bypass Graft• Heart Attack• Kidney Failure (Chronic)

• Major Organ Transplant (Kidney, Lung, Liver, Heart , Pancreas)• Stroke

The benefit has a termination age of 65 years. T’s & C’s Apply

Dial OR +(267) 390 3066 for assistance.

Value Add BenefitsSevere Illness Benefit

• Remote medical advice & information• Emergency medical assistance• Emergency response to scene• Pre hospital medical transportation• Inter hospital transfer• Upgrade transfer• Downgrade transfer

• Medical repatriation• Repatriation of mortal remains• Emergency transportation of medical products• Liaison with next of kin• Escorted returns of minors• In hospital medical monitoring

Women’s Health i) Pap smear for women aged 25-55 years once in two years. ii) Mammogram for women aged 40-70 years once in two years.

Men’s Health i) Prostate Specific Antigen (PSA) for men aged 40 years and above once in two years.

Young Children and Aged Adultsi) Flu vaccine once a year for members aged 10 years and below.ii) Flu vaccine once a year for members aged 65 years and above. iii) Flu vaccine one a year for vulnerable groups (e.g. members with certain and immunosuppression).

Diabetes: i) Blood glucose test for members aged 35 years and above once a year.

Cardiac Diseases i) Blood cholesterol test for members aged 35 years and above once a year.

HIV/AIDS i) HIV rapid test for members aged 16 years and above once a year.ii) HIV Elisa test for members aged 16 years and above as a confirmatory test following a positive rapid test .iii) Post Exposure Prophylaxis for high risk groups (e.g healthcare personnel and rape victims).

Glaucoma Screeningi) Glaucoma screening test for members aged 40 years and above and high risk individuals (e.g. members with family history of glaucoma and members with diabetes).

This benefit is designed to help members with prevention and early detection of certain illnesses/medical conditions. The benefit covers the following:

T’s & C’s Apply

Screening and Prevention Benefit

Value Add Benefits

Notes: Benefits available only where service is given by Bomaid approved service providers. Managed care, clinical protocols and scheme rules apply. 100% payout by scheme. Bomaid tariffs strictly apply.

| 4 | IS HEALTH PLAN BENEFIT 2017 | |5

Overall Scheme Benefit LimitHospitalisation maximum * (daily maximum room rate at agreed tariff **)Professionals fees Doctors and Other ProfessionalsRadiologyPathologyPsychiatry ^ (in-patient cover in a recognised psychiatric facility, includes professional fees) Prosthesis ^ (external and internal)Sub-acute care (post admission step down - maximum 30 days)Laser refractive eye surgery * (referrals from approved Ophthalmologist/Optometrist)

Managed Care BenefitsChemotherapy, radiation therapy and brachytherapy ** (pre-authorisation required)Chronic medications (supplied through the managed care program in accordance with the Bomaid list of approved chronic conditions) Registration with the Bomaid managed care program required.ARV therapy (supplied through the managed care program) Registration with the Bomaid managed care program required.

Outpatient Medical CareConsultations (General practitioners and Specialists)Procedures (medical/surgical)Diagnostic/Investigative CarePathologyXray/UltrasoundMRI/CT scansMedicationsDoctor dispensed medications (for acute cases only)Over the counter medications Pharmacy dispensed medicine (includes dental & ophthalmic prescribed medications)

Dental Care - Dental Overall Limit (subject to managed care protocols)In-patient dentistry * (the following sub-limits will apply)Hospital feesDentist feesAnaesthetist fees

In-Hospital BenefitsThe services provided under this benefit include Consultations, Drugs, Investigations & Procedures.

** Where fixed fee arrangement has been entered into, those fees will apply ° Guaranteed ^ Cover on assessment *Pre-authorisation required

Day-to-Day Benefits

825,269374,500150,000up to 150,000up to 150,000up to 150,00040,000

30,00013,6004,500

130,000

36,000

12,000

6,5202,0704,45010,8002,0001,800

7,0005,200750

2003,750

48,249

22,00012,0005,5004,500

ISBENEFICIARY

IS

Specialised dental treatment and oral surgery **Simple maxillo-facial surgery: acute or chronicOrthodontic treatment ˜ (braces, retainers and related appliances) for members 26 years and belowOut-patient dentistry (the following sub-limits will apply)Basic dentistry (includes consultations, radiology, filling, extraction, cleaning, scaling and polishingincision and drainage, root canal treatment)Specialised dentistry˜ (includes crowns, bridges and dentures)**Orthodontic treatment ˜ (braces, retainers and related appliances) for members 26 years and above

Designated Service Providers (managed care protocols apply) - comprehensive cover and reduced levels of copayment .Non-Designated Service Providers (managed care protocols apply)ConsultationClear aquity single vision lenses (per lens)Clear aquity bifocal a lenses (per lens)Clear aquity multifocal lens (per lens)Frame and/or any lens enhancementsContact lenses (only claimable as an alternative to frame and lenses)

Appliances Overall LimitGeneral appliancesMedical appliances (including glucometers, nebulisers)Surgical appliances* (for non-permanent disability) ( to be recommended by surgeon/orthopaedic surgeon) (includes knee/collar/chest/foot braces, crutches and walking frames) Wheel chairs, crutches and walking frames (for permanent disability)Hearing aid* (maximum 1 pair of appliances per 2 year cycle)

Allied Health Services Rehabilitation TherapyPhysiotherapy~ (motivational report needed for cases requiring more than 20 treatment sessions)Occupational therapy~Speech therapy~Clinical psychology~

20,000up to 20,000up to 20,000

6,249up to 6,249

up to 6,249

up to 6,249

1305007501,2009002,500

9,0004,500700700

up to 4,500up to 9,000

7,506

6,506

3,2533,2533,253

**Pre-authorisation required ˜ Refers to treatment every 2 years Level 1 and 2 conservative services and specialised services per specified dental protocols. Dentures limited to 1 plastic denture per 24 month cycle and are only available for members older than 21 years.

Optical Care

Appliances

*Prescription required

Allied Health Services

Medical referral needed

BENEFICIARY

2017 | |7| 6 | IS HEALTH PLAN BENEFIT

(Subject to Managed Care Protocols) Global Fee includes related costs of pre-operative testing & post-operative care within 1 month of procedure

This benefit is designed to provide a 100% cash payout to the life assured on 1st diagnosis of any of the pre-defined severe illnesses regardless of the actual medical expenses incurred.

This a benefit which comes at no additional cost to the member.

The Bomaid Funeral Benefit Top Up is an optional benefit that allows the member to choose a cover that suits their needs.

This cover is in addition to the basic funeral benefit the member already receives. This benefit can be purchased separately as an optional add-on to the existing benefit .

This benefit pays out cash to members per night of hospitalisation. The benefit is voluntary and is purchased separately as an optional add-on to the existing benefit .

The cash payout , amongst other things, can be used to meet members’ expense that may arise as result of being hospitalised.

IS

1,600

20,000

10,000

BENEFICIARY

This is a program to help members with management of chronic ailments and includes benefit management & clinical advise. The following conditions are covered under this program:

Managed Care Program

HIV/AIDS is a chronic condition managed under the HIV/AIDS Assistance Program.

Assistance Provided by Bomaid is as follows:• Cover for antiretroviral drugs• Cover for laboratory monitoring tests• Psychosocial support (counselling) including adherence counselling• Cover for hospitalisation related to HIV/AIDS and/or opportunistic conditions• Regular monitoring, evaluation and reporting• Each individual enrolled on the program will be assisted with up to P12,600.00 per annum for ARV drugs &

laboratory tests.• ARV Drugs are provided through the Bomaid Managed Care Program only.• Hospitalisation cover for HIV/AIDS related conditions is only available to members enrolled on the program.

NEUROLOGICAL &PSYCHIATRICEpilepsyParkison’s DiseaseMigraine (Excludes acute attacks).Bipolar DisorderChronic AnxietyChronic DepressionSchizophrenia

MUSCULOSKELETAL

ArthritisAnkylosing SpondylitisGoutOsteopoeniaOsteoporosis

OPTHALMIC

Glaucoma

CARDIOVASCULAR

Chronic Heart DiseasesHypertension

RESPIRATORYAsthmaAllergic Rhinitis (only if associated with Asthma)Chronic BronchitisChronic Obstructive Pulmonary Disease

ENDOCRINE

DiabetesThyroid Dysfunction

RENAL

Chronic Renal FailureChronic Kidney Diseases

GASTROINTESTINAL &METABOLIC

Inflammatory Bowel DiseaseHypercholesterolaemiaPeptic Ulcer Disease

AUTOIMMUNE

Multiple SclerosisPsoriasisSystemic Lupus Erythematosus

URINARY TRACT

Benign Prostate Hypertrophy

INFECTIOUS DISEASES

HIV / AIDS

For more information

Bomaid

www.bomaid.co.bw

+267 3633100

For more information

Bomaid

www.bomaid.co.bw

+267 3633100

Safe Male Circumcision

Severe Illness Benefit

Funeral Benefit

Funeral Benefit Top upT’s & C’s Apply

Hospital Cash Plan

T’s & C’s Apply

RIP

2017 | |9| 8 | IS HEALTH PLAN BENEFIT

Local: +(267) 3633 282 | South Africa: +(27) 11 259 5115/5000 | After Hours: +(267) 71 300 036

• 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

To process a pre-authorisation request , the following is required:

1. In-patient and Managed Care Benefits:

Pre-authorisation is required for all cases. Scheme and/or managed care protocols will be applied. Post-admission step down cover includes sub-acute care, hospice, private nursing and physical rehabilitation for approved clinical conditions. Excludes old age homes and frail care.

Chronic medicines will be covered under the chronic medication benefit only if supplied through the Bomaid designated pharmacies. Any chronic medicines supplied outside the designated pharmacies will be covered under the pharmacy benefit . No cover for ARVs supplied outside the Bomaid designated pharmacies.

2. Medical/Surgical Out-patient Benefit:

No cover for infertility treatment procedures.

3. Pharmaceutical Benefit ManagementGeneric reference pricing (GRP) will apply to all schemes except Scheme C. Under the GRP, a brand-name medicine that has a generic equivalent registered in Botswana and available at the point of service will be reimbursed up to the tariff of the generic equivalent .

Members will not pay the 10% co-payment should they opt to take the available generic medicines.Members will pay the difference between the tariff of the brand-name medicine and the generic equivalent should they opt to take the brand-name medicine while there is an available generic equivalent .

4. Dental Benefit:Maximum 2 preventative treatments per beneficiary per annum (e.g. cleaning, scaling and polishing).Re-treatment (e.g. filling) of a tooth within one year will be subjected to managed care and clinical protocols.Cover excludes: orthognatic (jaw correction) surgery, professionally applied fluoride, dental bleaching and implants.

Pre-authorisation is required for all in hospital dental procedures as well as specialised dentistry (including orthodontic treatment , crowns, bridges and dentures). Pre-authorisation is NOT required for surgical procedures done under local anaesthesia in out-patient rooms. A two-year benefit cycle applies for specialised dentistry (including orthodontic treatment , crowns, bridges and dentures).

5. Optical Benefit:

Reduced levels of member co-payments for services obtained from designated service providers. A two year benefit cycle applies (excludes consultations).

6. Appliances Benefit:

One wheel chair per beneficiary over a 3 year cycle.One pair of hearing aids per beneficiary over a 2 year cycle.

7. Allied Health Services Benefit:

Occupational therapy, speech therapy and clinical psychology benefits exclude therapy for social, educationaland developmental problems. Alternative treatment claim payments will only be made to members and not service providers.

8. Safe Male Circumcision:Cover includes pre-operative consultation/counselling, physical examination, HIV test and post-operative care within 1 month of operation.

9. Screening and Prevention Benefit:

No pre-authorisation required. 100% payout of the scheme tariffs. Members liable for VAT where applicable.

Additional Notes

International StudentHealth Plan

| 10 | IS HEALTH PLAN BENEFIT

n No 10% Co-paymentn No waiting periodn No VAT

www.bomaid.co.bw

bomaid@bomai.co.bw