Changes in Pula Medical Aid Fund Rules and Benefits Effective 01 July 2012

As a valued member of Pula Medical Aid Fund (PULA), you might be aware that at the Members’ Special General Meeting (SGM) held on 21 October 2011, the general membership resolved to accept proposed changes to the Fund Rules as presented by the Board of Trustees (BoT).

These changes include, amongst others, those aimed at improving process efficiencies, restructuring of the contribution tables to ensure alignment of member contributions with benefit utilization; as well as improvements in the benefits available to members.

The changes to the Rules were necessitated by among others:

  • Concerns raised by the general membership during the past Annual General Meetings (AGMs) regarding the erosion of the value of the benefits by inflation, inadequacy of some of the benefits limits and the lack of cover in respect of some categories of treatment i.e. the limitation and/or exclusion of certain preventative treatment and/or prophylactic benefits.
  • Developments (e.g. regulatory) in the environment that the Fund operates in; as well as the need to improve administrative and operational efficiencies of the Fund.

The Draft Fund Rules were subsequently approved by the Registrar of Deeds on 19 January 2012 and have been implemented effective 01 July 2012. Given the time it has taken to communicate the decision and subsequent implementation of the new Rules, we wish to sincerely apologise for this late communication.

Nevertheless, we are pleased to provide information on some of the benefits changes and introduction of a new class of membership as follows:

De-Luxe Benefit Option

Category

Old Limit (Pula) New Limit (Pula)
Confinement/Maternity (Facility Fees only)    
Normal delivery 8,000 per beneficiary per annum 8,640 per beneficiary per annum
Caesarian Section 12,650 per beneficiary per annum 13,650 per beneficiary per annum
Specialized Dentistry 5,500 per family per annum 8,800 per family per annum
Prosthesis used in surgery 20,000 per case per annum 50,000 per case per annum
Optical 1,600 per beneficiary per annum 2,500 per beneficiary per two financial years
Chronic Medication 12,000 per family  per annum 15,000 per beneficiary per annum

 

Other Benefits changes

Paramedical Services (Audiology, Speech Therapy, Chiropody, Clinical Psychology, Occupational Therapy and Registered Dietician) Limit has been improved to a block limit of P7 200 per member per annum. This means that should a beneficiary (patient) require, out of the block benefit, only Clinical Psychology services then P4 800 will be available. However, where services required within the block are more than one (1), then all services will be paid for up to the P7 200 block limit.

Funeral Benefits - Deluxe Benefit Option

Category

Old Limit (Pula) New Limit (Pula)
Member 4 000 8 000
Spouse 4 000 8 000
16 - 21 yrs. 2 500 5 000
6 – 16 yrs. 1 500 3 000
0 – 6 yrs. 900 1 800

 

Standard Benefit Option

Category

Old Limit (Pula) New Limit (Pula)
Confinement/Maternity (Facility Fees only)    
Normal delivery Up to Overall Annual Limit 8,640 per beneficiary per annum
Caesarian Section Up to Overall Annual Limit 13,650 per beneficiary per annum
Specialized Dentistry 2,079 per beneficiary per annum 3,000 per beneficiary per annum
Optical 385 per beneficiary per annum 1,200 per beneficiary per two (2) financial years


Other Benefits changes

Paramedical Services (Audiology, Speech Therapy, Chiropody, Clinical Psychology, Occupational Therapy and Registered Dietician) Limit has been improved to a block limit of P4 800 per member per annum. This means that should a beneficiary (patient) require, out of the block benefit, only Clinical Psychology services then P4 800 will be available. However, where services required within the block are more than one (1), then all services will be paid for up to the P4 800 block limit.

Funeral Benefits - Standard Benefit Option

Category

Old Limit (Pula) New Limit (Pula)
Member 2 000 4 000
Spouse 2 000 4 000
16 - 21 yrs. 1 500 3 000
6 – 16 yrs. 900 1 800
0 – 6 yrs. 600 1 200


For both the Standard and the De-luxe benefit options, the following benefits have been introduced Safe Male Circumcision (SMC) for HIV prevention only, and oral (the Pill) contraception.

Introduction of Individual Membership

This new class of membership is available to;

  • a member who after termination of membership gained through an employer group,  or
  • a dependant of a member who after reaching the age 21years (not schooling) or 25years wishes to continue to be a member of PULA.

Kindly note that should you require any further clarification and/or additional information, our Client Relations and Sales & Marketing officers are available and can be contacted on the following numbers: 365 0555 and 365 0596.

Members are advised that the revised Rules and Benefits are available on the PULA website at; www.pulamed.co.bw.

On behalf of the Board of Trustees and on our own behalf, we wish to thank you for your support and co-operation over the years.  We further urge members to continually update their contact details in order to ensure timely communication with the Fund. Such contact detail updates should include e-mail (where available) and mobile phone numbers.

Yours faithfully,



DUNCAN THELA