Medical Aid Funds
Medical Aid can be described as the business of undertaking liability in return for a premium or contribution-
• To make provision for the obtaining of any relevant health service
• To grant assistance in defraying expenditure incurred in connection with the rendering of any health service;
• Where applicable, to render a relevant health service, either by the medical aid fund itself, or by any
supplier or group of suppliers of a relevant health service or by any person, in association with or in terms of an agreement with a medical aid fund.
In terms of the NBFIRA Act, Medical Aid Funds/Scheme (“MAFs”) are regulated and supervised by NBFIRA. There is however currently no subordinate regulations and rules to license and monitor the MAFs effectively.
In this regard, in 2012 NBFIRA engaged Consultants (KPMG) to conduct research- which was Phase 1 of the project-on the current MAFs industry setup and recommend to NBFIRA whether to draft a new and specific legal framework which introduces Regulations and Rules for MAFs or to transform the MAFs to underwrite health insurance as insurers under the regulation and supervision of the Insurance Industry Act.
The report from this study established the need for a clear and separate regulatory framework that will protect the contributions of members, ensures the sustainability of the industry and most importantly continues to provide health care funding to Batswana. It was recommended that new regulations and rules be promulgated to cater for this.
Following the above report, NBFIRA has recently awarded a tender for the development of regulations and rules under phase 2 of the project.
The MAFs that are currently registered with NBFIRA are the following:
• Botsogo Health Plan
• Botswana Medical Aid (BOMAID)
• Botswana Public Officers’ Medical Aid Scheme (BPOMAS)
• Call A Doctor (Pty) Ltd t/a Itekanele Health Scheme
• Doctors (Pty) Ltd t/a Doctors Aid Medical Aid Scheme
• Pula Medical Aid Fund
• Wastikc Consortium (Pty) Ltd t/a Etudiant Medical Aid
• Botlhe Medical Aid (Pty) Ltd
• Symphony Health
Currently the MAFs only cover about 18% of the population of Botswana and as at end of December 2014 the MAFs covered 385,470 lives categorized as follows:
a) Principal members 149,295
b) Dependents 236,175