Premium Waiver Benefit

The Fund has introduced a Premium Waiver for all its members starting 1 July 2016. A premium waiver benefit simply means that, when you pass-on (die) your family will remain covered at no cost for the next 12 months.

Preventive Care Benefit 

We have also introduced Preventive Care to members on the Deluxe Benefit and Executive options. You now have access to HIV tests, annual medical examinations, tests for early detection of cancer in ladies and men and an array of other wellness tests. We believe that ‘Prevention is still the best cure’.
 

The following are subjected to Pre-Authorisation;

• MRI & CAT Scan, Confinement and Facility Fees, In-patient Hospitalisation, Medical Assistive Devices, Medical and Surgical Appliances, Specified Sickness Conditions, Safe Male Circumcision

The following are subjected to case management;

• Confinement and Facility Fees, In-patient Hospitalisation

All PULA Members and their dependants on PULA are entitled to Funeral Benefit.

The following are the required documents;

• copy of death certificate or death notification, with the nominee letter from the authority on who to receive the benefit on behalf of the family if the Principal Member is late.
• The Funeral benefit pay out varies according to status of Member, spouse, child etc. Maximum payout is P13,000

PULA members have access to 24hr emergency medical assistance and support at no additional cost. This arrangement is facilitated through a contract with Emergency Assist (EA991). The provider was appointed in March 2016. 

The service includes; 

• Emergency Medical evacuation.
• Inter-hospital Transfer
• Repatriation of mortal remains, and 
• Remote medical advice and information
• Ground and Air Emergency Medical Assistance
• Access to 24 Hour contact centre

All subscribing members of PULA and their registered dependants are covered free of charge. 

To call Emergency Assist in case of Medical emergency:
991 or (+267) 390-4537

There are four (4) applicable waiting periods for new members:

• Maternity - 9 months
• Specialised/Limited dentistry - 12 months
• Pre-existing conditions- 24 months.
• Infants not registered within 30 days of birth - 3 months

The waiting periods do not apply to anyone who joins the fund and has been a registered member or dependent of a recognized medical aid Scheme for a continuous period of at least one (1) year and the application to join PULA is made within three.

Students

• We offer individual membership that provides students who are not dependents an opportunity to be a member of a medical aid. Our flexi benefit option is designed to cater for the young, healthy price sensitive individuals with an out-patient coverage of up to P60 000 annual cover.

Parents

• Often times we seek coverage for parents who are in need of chronic cover, physiotherapy and optical benefit. We offer you Executive, Deluxe and Galaxy benefit options to open for your parents in order to enjoy such coverage.

Long term partners

• Now individuals no longer have to wait for marriage to enroll their loved ones in our medical aid. One can easily open an account for those they care about and pay their monthly contributions to ensure they too enjoy medical aid cover.

Extended Family Members and Other loved ones

• With our benefit options, one can easily identify the benefit option suited for their relatives and other loved ones’s medical needs and affordability of the option to enroll them. With Executive and Deluxe benefit options, your relatives get dread disease cover from P500 000 to P700 000. Simply open an account for them by filling out the application form and pay monthly contributions in advance.

Continuing PULA Members

• PULA individual membership is also available to employees who are on PULA but no longer with their employer and wish  to continue with their membership
• Dependents of members who can no longer be dependents (e.g. due to divorce or age) but wish to continue their membership or members of the Fund or their dependents also qualify.
   

For Members who previously have been with Pula for at least one financial year are eligible to continue with their membership under pension. Members are required to notify the Fund 90 days before retirement. 

Membership Cards are sent by post to members 2 weeks after submitting a complete application form with copy of pay slip and ID, copy of marriage certificate if you are adding your spouse and copy of birth certificates if you are adding child dependants.

The following qualify to be covered as dependants on PULA; legally married spouse, biological and legally adopted children. Children are covered from the age of 0-21 years, and can only continue with cover if they are still at school. A confirmation letter from the school will be required on an annual basis.

Benefits Include;

• Regular telephone check-ups and e-mail notifications. Advice and educational materials throughout the various stages of pregnancy for both the expectant mother and expectant father A hamper bag on the last trimester of the pregnancy which includes contact list of service providers locally and in South Africa and educational materials on the mother and the baby’s health. Members who are 16 weeks pregnant or more can register through marketingold@afa.co.bw

You may want to take note that as a medical aid provider our duty is towards restoring your health for medically recognised treatments, the following may not be covered:

• Obesity 
• Personal reasons 
• Self-inflicted injuries
• Infertility
• Injuries arising from professional sport, speed contests and speed trails
• Purchase of; Medicines not included in the prescription form
• Patented foods, including baby foods
• Applicators, toiletries & beauty preparations
• Condoms, morning after pill
• Household and biochemical remedies
• Tonics, slimming preparations and drugs as advertised to the public 
• All costs for medical examinations other than those ordered by a medical doctor in order to determine treatment for a sickness condition 
• Holidays for recuperative purposes Treatment or surgery not medically necessary 

However we constantly review the list of items not covered. Contact our Call Centre to consult on different covered items.
 

Call Centre 

3650500/ 576/575 

Check the website for any forms, AGM reports,  annual financial statements and post your requests on contact Us.

PULA Website 

www.pulamed.co.bw 

For all queries relating to Pre-authorizations, Chronic medicines, HIV/AIDS and Wellness.

Managed Care Department 
365-0574, 365-0509, 365-0573 
casemanagement@afa.co.bw 

Do you have any queries on your account, or any unpaid medical bills? Contact Client Services for speedy resolution.

Client Services 
365-0547, 365-0529 
ClientServices@afa.co.bw 

If you want to join Pula or have general questions about products and services.

Marketing Department 
marketingdepartment@afa.co.bw 
3650586/04/96 

Submitting Claims from your doctors?

Claims Department 
ClaimsDepartment@afa.co.bw