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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 commencement date of cover.
- Prospective members shall, prior to admission, complete and submit the application forms required by the Scheme, together with satisfactory evidence in respect of himself and his dependents, of age, income, state of health and of any prior membership or admission as dependent of any other medical aid scheme. All applications are to be verified by the employer.
- 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 commencement date of cover.
- Prospective members shall, prior to admission, complete and submit the application forms required by the Scheme, together with satisfactory evidence in respect of himself and his dependents, of age, income, state of health and of any prior membership or admission as dependent of any other medical aid scheme. All applications are to be verified by the employer.
Dependents
Who qualifies to be a dependent
- Your spouse or partner who is not a member or a registered dependent of a member of another medical scheme who has not yet reached the age of 55 years.
- A dependent child who is not a member or a registered dependent of a member of another medical scheme
- Dependent blood relative of a member (parents, brothers and sisters- subject to assessment and contract between Employer group and Botsogo) in respect of whom the member is liable for family care and support who has not yet reached the age of 55 years.
How to register dependents
- Newborn babies or newly adopted children must be registered as dependents within 30 days of the date of birth or adoption of the child. Increased contributions shall then be due as from the first day of the month following the month of birth or adoption. A birth certificate or legal adoption papers will be required.
- For newlyweds, principal members must add the new spouse under the scheme within 30 days of marriage. A marriage certificate will be required.
- Your spouse or partner who is not a member or a registered dependent of a member of another medical scheme who has not yet reached the age of 55 years.
- A dependent child who is not a member or a registered dependent of a member of another medical scheme
- Dependent blood relative of a member (parents, brothers and sisters- subject to assessment and contract between Employer group and Botsogo) in respect of whom the member is liable for family care and support who has not yet reached the age of 55 years.
How to register dependents
- Newborn babies or newly adopted children must be registered as dependents within 30 days of the date of birth or adoption of the child. Increased contributions shall then be due as from the first day of the month following the month of birth or adoption. A birth certificate or legal adoption papers will be required.
- For newlyweds, principal members must add the new spouse under the scheme within 30 days of marriage. A marriage certificate will be required.
Termination of membership
Your membership will be terminated:
- If the scheme receives 1 month notice of cancellation from the employer group in which you are participating.
- One calendar month written notice for termination of dependents, where dependents no longer meet the conditions of being a dependent as per the scheme rules
- In the event of death
- Failure to pay amounts due to the Scheme on the due date (contributions)
- If Botsogo has evidence of abuse of privileges offered to you as a member e.g false claims, misrepresentation and non-disclosure of factual information
- If the scheme receives 1 month notice of cancellation from the employer group in which you are participating.
- One calendar month written notice for termination of dependents, where dependents no longer meet the conditions of being a dependent as per the scheme rules
- In the event of death
- Failure to pay amounts due to the Scheme on the due date (contributions)
- If Botsogo has evidence of abuse of privileges offered to you as a member e.g false claims, misrepresentation and non-disclosure of factual information
Change of option
Option Changes are only allowed effective June of each year. Botsogo Health Plan
needs to be informed 30 days in advance.
Underwriting
Underwriting is a process where the Medical Scheme determines whether cover will be
offered and if so, the extent of the risk of the applicant and premium rate applicable.
Waiting periods as per section 10.4 of the scheme rules will apply depending on the
results from the underwriting process.
Your Responsibility as a member
- To understand how Botsogo Health Plan and your specific healthcare option
works
- To read and understand the Bosogo Health Plan Scheme rules
- Keep Botsogo up to date of any changes to your personal details
- Check all accounts from the healthcare service providers ( doctors, pharmacies etc)
- Inform Botsogo Health Plan before you or any of your dependents are admitted to the hospital and obtain pre-authorization.
- Keep your membership card safe to ensure that no other person can use it fraudulently and ensure that it is presented to service providers along with identification at each visit
- Read all correspondence from Botsogo Health Plan, such as general correspondence, welcome packs etc. These will keep you informed in terms of the latest developments
- To read and understand the Bosogo Health Plan Scheme rules
- Keep Botsogo up to date of any changes to your personal details
- Check all accounts from the healthcare service providers ( doctors, pharmacies etc)
- Inform Botsogo Health Plan before you or any of your dependents are admitted to the hospital and obtain pre-authorization.
- Keep your membership card safe to ensure that no other person can use it fraudulently and ensure that it is presented to service providers along with identification at each visit
- Read all correspondence from Botsogo Health Plan, such as general correspondence, welcome packs etc. These will keep you informed in terms of the latest developments