Your benefit entitlement will depend on the option you choose between the three benefit options that the scheme has, Standard Benefit Option, High Benefit Option or Premium Benefit Option. For members on High Benefit and Premium Benefit, when you and any of your dependants fall sick, the Scheme will settle 90% of the medical expenses up to the specified limits: within the prescribed Rules. You have the responsibility of settling the remaining 10%. For members on Standard Benefit Option, the scheme settles the medical bill 100%. You get value for money, excellent service and health.
Your claims are settled twice a month. The Scheme will pay suppliers directly if a valid membership card is produced before treatment. Members on High Benefit and Premium Benefit Options have a Dread Disease of P165 000 for members on High Benefit and P300,000 for members on Premium Benefit which applies to 10 specified conditions namely: Heart Attack, Coronary Heart Disease, Stroke, Cancer, Kidney Failure, Organ Transplant, Paraplegia, Blindness, Multiple Sclerosis and Motor Vehicle Road Traffic Accident.
The Scheme also has other benefits that it offers to the members and their covered dependents at no extra cost, this benefits include; funeral benefit up to P12,5000, Premium waiver and a medical emergency evacuation service, of international standing; through Med Rescue International (MRI) Botswana.
