1. Eligibility
Membership is open to employees of an employer group who have a contract with Botsogo Health Plan. The employer and employee must be residing in Botswana. Individuals who are not part of the participating employer group are not eligible for membership.
The maximum entry age to the scheme is 55 years.
The benefit year for Botsogo Health Plan runs from 01 June to 31 May of the following year. Benefits will be prorated from the commencement date of cover.
Prospective members must complete and submit the required application forms, together with satisfactory evidence of age, income, state of health, and any previous medical aid scheme membership. All applications must be verified by the employer.
2. Dependents
Who qualifies to be a dependent
- Your spouse or partner who is not a member or registered dependent of another medical scheme and has not reached the age of 55 years.
- A dependent child who is not a member or registered dependent of another medical scheme.
- A dependent blood relative (parents, brothers, or sisters), subject to assessment and agreement between the employer group and Botsogo Health Plan, for whom the member is responsible for family care and support, and who has not reached the age of 55 years.
How to register dependents
Newborn babies or newly adopted children must be registered within 30 days of birth or adoption. Increased contributions will be effective from the first day of the month following birth or adoption. A birth certificate or legal adoption papers are required.
For newly married members, the new spouse must be added to the scheme within 30 days of marriage. A marriage certificate is required.
3. Termination of Membership
Your membership will be terminated if:
- The scheme receives one month’s notice of cancellation from the employer group.
- One calendar month’s written notice is received for termination of dependents who no longer qualify.
- The member passes away.
- Contributions are not paid by the due date.
- Botsogo Health Plan has evidence of abuse of membership privileges, including false claims, misrepresentation, or non-disclosure of material information.
4. Change of Option
Option changes are only permitted from June each year. Botsogo Health Plan must receive 30 days’ notice before the requested change.
5. Underwriting
Underwriting is the process whereby the Medical Scheme determines whether healthcare cover will be offered and, if approved, the extent of the risk and the applicable premium.
Waiting periods, as outlined in Section 10.4 of the Scheme Rules, may apply depending on the underwriting assessment.
6. Your Responsibilities as a Member
- Understand how Botsogo Health Plan and your selected healthcare option work.
- Read and understand the Botsogo Health Plan Scheme Rules.
- Keep Botsogo Health Plan informed of any changes to your personal details.
- Check all accounts received from healthcare providers such as doctors and pharmacies.
- Inform Botsogo Health Plan before you or your dependents are admitted to hospital and obtain pre-authorisation.
- Keep your membership card secure and present it, together with valid identification, at every healthcare visit.
- Read all correspondence from Botsogo Health Plan, including welcome packs and general notices, to stay informed of the latest updates.
