June 2025 Edition | Powering Progress Through Smart Healthcare Partnerships

Principal Officer’s Foreword

Dear Valued Member,
Welcome to the June 2025 edition of Pulamed Pulse.This month has been marked by meaningful engagements and exciting developments. From our participation in the Future of Mining Summit, to hosting impactful HR Connect sessions at Letlhakane and Gaborone, we’ve been driving important conversations around employee wellbeing and healthcare sustainability.
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We’ve also introduced benefit enhancements, implemented contribution adjustments, and made strides in billing, reconciliation, and membership processes—all aimed at improving your overall experience.
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In our commitment to knowledge sharing, we proudly supported the IAPP Knowledge Net Launch, a platform designed for conversations focused on cultivating a culture that upholds the respect, protection, and value of personal data across its entire lifecycle.
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As part of our drive for transparent communication, we’re Live on Radio every week. Tune in for updates, health tips, and Scheme insights— every Tuiesday on Gabz FM from 1800hrs-1900hrs.
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Lastly, I encourage you to help shape the future of this newsletter through our “Rate Us” platform. Your feedback is key to delivering the value you deserve.
Thank you for your continued trust and support as we work together to build a more inclusive and member-focused Pulamed.
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Dr. Khumoetsile Mapitse
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Yours in Health,
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Dr. Khumoetsile Mapitse
‍Principal Officer

Member Benefit Spotlight

2025/26 Financial Year Benefit enhancements and contribution increases

At Pulamed, our commitment is to provide sustainable, comprehensive, and meaningful healthcare cover to our members. Every year, we undertake a rigorous review of our benefits — driven by member feedback, claims data, and usage patterns — to ensure we remain responsive and relevant.
For the 2025/2026 benefit year, we’ve enhanced several key areas of cover, including:

Total cover

Increased Annual overall limits across Executive, Deluxe, Galaxy, Standard while Flexi remains the same.

Medicines

Expanded access to acute, chronic, and over the counter (OTC) medication – The aim of these increases is to ensure that members do not run out of much needed medicines during the year . Over The Counter development means Members can now access select medications without prescriptions, improving treatment flexibility and improving access to medication.
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The overall medicine benefits are as follows;Executive – Up to P 13 500, Deluxe Up to P 9 000, Galaxy Up to P 6 182, Standard P 6 182 and Flexi P 4 000.
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Psychiatry Medicines:
‍In recognition of the increasing awareness of mental health, the Fund has bolstered its mental health offering. The benefit has been increased to cater for the chronic nature of the treatment as follows:
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Executive Option: P15,000 to P30,000 Deluxe Option: P15,000 to P20,000 Galaxy Option: P9,700 to P10,000

Dread disease

(Cancer, Stroke, Heart attack so on and so forth) this benefit has been increased for the Executive and Deluxe Benefit Options. Under Executive, Dread Disease has been increased from P700,000 to P1,000,000, whilst Deluxe Dread Disease has been increased from P500,000 to P700,000. Please note that dread disease benefit remains a per family per annum benefit and not a once in a lifetime benefit because the Fund understands the gravity of Dread Disease and wants to ensure that members are afforded the necessary treatment they require.

Internal prosthesis

For Executive and Deluxe Members, prosthesis benefit limit have been increased by up to 100% to cater for the increasing cost and technological advancement of prostheses.

Galaxy Hospitalisation

Hospitalisation benefit for the Galaxy Benefit Option has been increased from P50,000 to P75,000 per annum. Moreover, the Overall Annual Limit of this Option, has gone up from P100,000 to P125,000.
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We’ve specifically upgraded benefits under Galaxy to ensure it’s a strong mid-tier option, appealing to members seeking value and wider cover.

Maternity cover with 100% delivery cover at selected facilities

Bokamoso Private Hospital, Francistown Academic Hospital, Riverside Hospital (Francistown), Debswana Jwaneng Mine Hospital, Debswana Orapa Mine Hospital, Doctors Inn (Maun), Maun Private Hospital. The Fund continually strives to ensure that expectant mothers do not pay out of pocket and continues to engage other providers to join the network of 0% co-payment.

Specialised Dentistry

The Fund has found it necessary to cushion the run-away out of pocket expenses that members incur for orthodontics treatments. To this end, Orthodontics treatment has been moved from specialised dentistry benefit and placed as a standalone benefit and has been allocated an annual benefit of P30,000 and P20,000 under the Executive and Deluxe benefit options respectively.
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Furthermore, Specialised dentistry for Executive and Deluxe options have been increased to P20,000 each.

General Practitioner (GP) Consultations

The GP consultations limit for the Galaxy Benefit Option has been increased from P2,000 to P3,000 per beneficiary per annum. GP visits under other Benefit Options remain unchanged and unrestricted.

Pulamed Processes

Membership Application processes

The membership application process is quick and straightforward

Submission Of Application

Mandatory Documentation:
- New member application form/ Continuing member application formCertified ID/Passport
- Proof of residence
- Proof of income
- Consent forms
- Debit order form (for individual applicants)
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Where applicable:
- Marriage certificate & Spouses’ certified valid ID/ passport (When adding ones spouse)
- Certified birth certificate (When adding ones child)
- Prior medical aid certificate (To avoid late joiner penalties and waiting periods )
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Submissions are made to – clientservices@afa.co.bw

Application Vetting

- Detailed review of the application
- Check for completeness (e.g., bank details, medical history,contact info)
- Verify all supporting documents and their validity
- Sanctions and PIP (Politically Influential Person) screening
- Adverse media checksAdditional vetting for high-risk cases

Expected Vetting Turnaround Time: [Same day] for vetting

Processing

This includes:
- Capturing data into our systems
- Assigning membership numbers
- Underwriting (where required)
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Expected Processing Turnaround Time: [1-3 days ]

Starter Pack Distribution

Once approved, members receive:
- A welcome text message
- A starter pack with their medical aid card & welcome letter
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Delivery Options:
- Office collection
- Postal delivery

Billing and Reconciliation

Our billing and reconciliation process ensures accurate contribution management and transparent financial reporting.
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• Breaking down the billing lifecycle, from invoice generation to reconciliation
• Highlighting the possible causes for discrepancies
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Overview of the Billing Cycle

Billing

Invoice and Bill shared with relevant parties
Employer group KYC is paramount to ensure billing is being shared to the correct individuals

Remittance

Failure to provide remittances may result in unallocated funds
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Remittances and POP are shared to accounts@afa.co.bw

Allocation

Funds allocated at member level

Payment

Reminders are sent after the 22nd of each month should payment not yet reflected.
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Paying as per invoice= auto
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Employer groups are requested to reference using their Group name and reference number

Incorrect referencing may result in several issues

Reconciliation

Compare billed amounts vs received amounts.
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Identify discrepancies:
- Overpayments
- Underpayments
- Non-payments
- Non-members
- Share reconciliation

Possible Causes of Underpayments
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• New dependants not being paid for
• Late Joiner fees not accounted for
• Employer group error in calculating payment/ system configuration
• Annual increment not accounted for
• Salary-based contribution not updated

Possible Causes of Overpayments
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• Duplicate payroll deductions
• Employer not aware of member changes (e.g., removing dependants)
• Employer group error in calculating payment/ system configuration
• Payment towards arrears
• Salary-based contribution not updated

Impact of Errors
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• Interrupted access to healthcare services for affected members
• Arrears may lead to account suspension or termination if unresolved
• Case management is unable to approve medical procedures for members with outstanding balances
• Higher administrative burden on both HR teams & finance teams

News & Events

Pulamed At The Future Of Mining Summit 2025

Pulamed was a proud sponsor and participant at the Future of Mining Summit for the 2nd year running. Dr. Khumoetsile Mapitse, CEO of Pulamed, has urged Botswana’s mining sector to support the country’s push for Universal Health Coverage (UHC) through a National Health Insurance (NHI) system. Speaking at The Future of Mining Summit 2025, he emphasized that UHC is a national priority, not just a health issue, requiring collaboration across sectors.
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Citing the World Health Organization, Dr. Mapitse stressed that UHC ensures everyone has access to quality healthcare without financial strain. He warned that Botswana is lagging, with only 15% of the population covered by medical aid and high out-of-pocket expenses burdening the uninsured majority.
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He clarified that while often confused with UHC, NHI is a funding tool aimed at equitable care by pooling resources, allowing the wealthy to subsidize the less fortunate. Dr. Mapitse also noted that NHI could help curb rising healthcare costs and ease the burden on employers struggling to provide healthcare benefits.

Pulamed hosts inaugural HR Connect 2025 in Letlhakane & Gaborone

Pulamed proudly hosted the HR Connect 2025 workshops at Letlhakane and Gaborone under the theme: “From insight to Action : The HR Advantage,” bringing together over 150 HR professionals from both locations.
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The Letlhakane session took place at the Thakadu Hotel, Casino and Conference Centre, while the Gaborone event was held at the Phakalane Golf Estate Hotel and Convention Centre.
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These highly interactive sessions fostered robust dialogue on employee wellbeing and smarter medical aid solutions, with participants showing high levels of engagement through active Q&As, group discussions, and practical scenario sharing.
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Key topics explored during the workshops included how medical aid works, onboarding processes, membership and contributions management, billing and reconciliation, benefit structures, value-added services, and effective communication touchpoints.

Pulamed at the IAPP knowledge Net Launch

Pulamed proudly supported the launch of the IAPP Knowledge Net on the 23rd of May 2025, Gaborone. In collaboration with Bookbinder Business Law BBL and other sponsors, this milestone event brought together privacy professionals for insightful conversations focused on cultivating a culture that upholds the respect, protection, and value of personal data throughout its lifecycle.
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The IAPP Knowledge Net is a global community of privacy and data protection professionals, offering certification, continuous learning, and collaboration opportunities. The launch event aimed to establish a formal platform in Botswana that aligns local efforts with international standards in data privacy—an increasingly critical area in today’s digital and regulatory landscape.
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Pulamed’s sponsorship reflects our strategic commitment to data privacy, particularly in the context of health information, which is considered highly sensitive. The partnership also reinforces Pulamed’s credibility in the personal data protection space, underscoring our role in advancing responsible data stewardship within the healthcare sector.

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