1 What Is The Objective Of The Fund?
PULA aims to establish a fund by contributions which will then be used to defray the healthcare costs of members and their beneficiaries.

2 Who Manages The Affairs Of PULA?
The Fund is managed and controlled by a Management Committee which is elected by the members. The Fund is administered by Associated Fund Administrators Botswana (Pty) Ltd (AFA).

3 Who Is Eligible To Participate?
Membership of the Fund is open to employees joining under the auspices of an employer. New employer groups must enlist a minimum of one (1) employee.

4 How Do I Become A Member?
In order to gain membership you must fill in the prescribed application form. This form must be counter-signed by your employer before submission to the Administrators for processing. The turnaround for applications is a week after receipt by the administrator.

There are two options to choose from: the Standard Benefit Option and the De-Luxe Benefit Option. These options differ in terms of contributions made and benefits received.

5 Who Can Be Covered As A Beneficiary?
The following persons may be listed as beneficiaries:

• Your spouse
• Your unemployed children up to the age of 21 years including legally adopted children,

Under special rules, a child over the age of 21 years but under 25 years, attending
school and whose remuneration does not exceed P258.00 (currently) per month.

6 What Medical Services Does The Fund Cover?
A wide variety of healthcare services are covered for the members benefit. Amongst them are medical, paramedical, home nursing, surgical, dental and optical services.

7 What Are The Benefits Of Joining The Fund?
Your benefit entitlement will depend on the option you choose; Standard benefit option OR De-Luxe benefit option. When any of your dependants fall sick, the Fund 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%. Furthermore, the more people there are in your group, the less you have to pay as an individual.

MEMBERS ARE EXEMPT FROM PAYING THE REQUIRED 10% CO-PAYMENT FOR BILLS EXCEEDING P30 000 PER ADMISSION/HOSPITALISATION EVENT

Advantages and Benefits

• You get value for money, excellent service and health
• Your claims are settled twice a month
• The Fund will pay suppliers directly if a valid membership card is produced before treatment.
• The Fund provides funeral benefits
• The Fund provides a medical emergency evacuation service, of international standing; through MedRescue International (MRI) Botswana.

Standard Benefit Option
This option offers a total of P40 000 in benefits per family per financial year. The contributions payable are much lower than those in the Deluxe option. In turn the benefits receivable are also much lower.

Deluxe Benefit Option
This option offers a total of P300 000 in benefits per family per financial year. Members also enjoy an added P500 000 in the form of Catastrophe/Dread Disease cover. This benefit covers 10 specified conditions.

8 Are There Any Waiting Periods Before Enjoyment Of Benefits?
Generally there are none, except in the following circumstances:

• Maternity benefits - 9 months from registration date
• Specialized Dentistry - 12 months from registration date
• Infants not registered within 30 days of birth 3 months from registration date.

Note: If you join the Fund within 3 months of leaving another recognized medical scheme and your previous membership was 12 months or longer, the waiting periods are waived.

9 How Much Are My Contributions?
Depending on the option you choose, your contributions are determined by three main factors:

• Your basic salary
• The number of dependants registered
• The stratum your group belong to, there are five strata
  • Groups of 1 - 10 employees
  • Groups of 11 - 39 employees
  • Groups of 40 - 74 employees
  • Groups of 75 - 99 employees
  • Groups of more than 100 employees

(Please note for the Standard Benefit Option there is only one stratum)

10 How Do I Pay My Contributions?
Contributions are based on your basic salary and the number of people covered under
your membership. Once assessed, you will pay a proportion (by salary deduction) of the amount while your employer contributes the rest. The entire amount will then be remitted by your employer to the Fund. For example, assuming that your contributions are assessed as P180, your employer may pay anywhere from 50% (P90) of this amount while you pay the balance (P90).

11 Are The Contributions A Constant Amount?
Generally, contributions are kept constant for a year at a time. Adjustments may be made from time to time; depending on the actual utilisation of benefits and the financial position of the Fund. By being prudent members can positively influence the maintenance of low premiums. The higher the claims, the higher the contributions and vice versa.

12 How Can I Help To Keep Costs Down And Therefore Premiums Low?
The key thing to remember is that this is your Fund, therefore, to keep your costs down you need to:

• Keep your body healthy through regular exercise. Discuss the cost and content of your treatment with your doctor (impressing the wish to receive the best care at the minimum cost available).
• Ensure that only those who are registered as your beneficiaries have the benefit of using your membership card when paying for services. This has the advantage of protecting your benefits against erosion, and keeping your monthly premiums low.
• Generally look after yourself well.

13 How Are The Funds Surpluses Utilised?
Surpluses are retained for future payment of benefits, while losses, if any, are made up by an increase in contributions.

14 Can One Individual Join The Fund?
The Fund only caters for people who participate as members of an employer group. However, a person who has been a member of the Fund for two years and who changes employment may still retain membership of the Fund, provided the new employer is willing to assume the role of other participating employer groups.

15 How Do I Make A Claim?
You may claim in either of two ways: you may choose to pay by presenting your membership card to your doctor, or you may, after making direct payment, mail or submit your claim and invoice to the Administrators. It is preferred that you opt for the former. It is convenient to you and the service provider.

16 Is The Card Well Recognized As A Means Of Payment?
Yes, close to 95% of health suppliers in Botswana will take the card as ready payment. Our guarantees also cover treatment obtained in South Africa.

17 Where Can I Obtain Further Information About The Fund?
Personnel at Associated Fund Administrators Botswana (Pty) Ltd., (AFA), who are the fund administrators, will be happy to give you detailed information and answer any questions . You may come personally, call or contact them at the following addresses:The Physical Address AFA House, Plot 61918, Showgrounds Office Park, GABORONE. The Postal Address P.O. Box 1212 GABORONE Tel.: (267) 3951166 Fax: (267) 3951165 Email:marketing@afa.co.bw