Principal Officer’s Foreword
Dear Valued Member,
Welcome to the May 2025 edition of Pulamed Pulse—a special issue centred on care, transformation, and our collective journey towards a healthier future.
This month, we shine a spotlight on our nurses—the unsung heroes of our healthcare system—whose compassion and dedication continue to make a life-changing impact across communities. We also unpack important developments, from simplified claims submissions to our evolving role in healthcare innovation and wellbeing.
Pulamed remains committed to open, transparent communication with you, our members. That’s why we’re proud to be Live on Radio every week—tune in to Gabz FM every Wednesday at 17:35 and RB2 every Thursday at 17:15 for updates, health tips, and Scheme insights.I invite you to take part in shaping your Pulamed experience. We’ve introduced a new “Rate Us” section to hear your thoughts and better tailor the content you value most.
Thank you for your continued trust as we build a sustainable, member-centric Scheme together.
Yours in Health,
Dr. Khumoetsile Mapitse
Principal Officer
Member Benefit Spotlight
CHILD IMMUNIZATIONS – PROTECT THEIR FUTURE
Immunizations are one of the most effective ways to keep your child safe from preventable diseases. Ensure your child is up to date with all the vaccines.
Pulamed will cover the following;
• Injection/Administration Fee (All vaccines as per Government schedule)
• Measles, Mumps & Rubella and Hepatitis A
• Any out-of-stock vaccines (As per Government schedule) -Service providers to notify Fund of vaccine unavailability
Visit your nearest clinic or talk to your healthcare provider for your child’s immunization schedule.
current benefits?
Follow these Steps
1. Download & Complete the Change of Benefit Option Form which can be accessed from https://pulamed.co.bw/forms
2.Attach Payslip (Corporate Member) or BankStatement (Individual)
3. Submit your request to clientservices@afa.co.bw
*Fund Rules Apply
Quick review of
Benefit Options
P2 Million Cover Per Annum
P1.2 Million Cover Per Annum
P100 000 Cover Per Annum
P40 000 Cover Per Annum
P60 000 Out-patient Cover Per Annum
Annoucements
Fraud, Waste and Abuse Series
– This Month’s Focus: ABUSE
Over the past two editions, we explored Fraud and Waste—two significant challenges that affect the sustainability of our medical aid fund. This week, we turn our focus to the third and equally critical area: Abuse.Abuse occurs when healthcare services or benefits are used in ways that are excessive, unnecessary, or inconsistent with accepted healthcare practices. While not always fraudulent, abuse often leads to unjustified costs, straining the resources of the Scheme and impacting every member’s pocket.
Examples of abuse include:
• Visiting multiple healthcare providers for the same condition without medical necessity (doctor hopping)
• Requesting brand-name medication when generics are available and effective
• Over-utilisation of benefits (e.g., unnecessary repeat consultations or tests)
• Service providers submitting claims for higher-level services than those actually rendered
• Members sharing their medical aid card with non-dependents
Why it matters:
Abuse inflates healthcare costs for everyone. When benefits are misused, the Scheme has to absorb the financial impact—leading to higher premiums and fewer resources for members with genuine, urgent healthcare needs.As a Pulamed member, you play a vital role in protecting the integrity of your Scheme.
• Use your benefits responsibly
• Question unnecessary tests or procedures
• Report suspicious activity anonymously to our Fraud Hotline
Let’s build a culture of accountability and fairness. Together, we can help preserve the quality and sustainability of our health coverage—for ourselves and for future generations.
Report Fraud, Waste & Abuse
REMEMBER, REPORTS CAN BE SUBMITTEDANONYMOUSLY OR IN CONFIDENCE
Pulamed Processes
The following are required and applicable when submitting medical claims for processing and reimbursement:
• Invoice – signed by the member or dependent.
The invoice should contain the following:
• Surname & initial(s) of the principal member
• First name and date of birth of the patient (asindicated on the membership card)
• Name of the benefit option
• Membership number of the member
• Valid Practice number, name and signature of thehealth professional/ service provider rendering theservice
• Signature of the member/ dependent acknowledgingreceipt of billed services
• Date on which services were rendered
• The nature of the service and valid ICD10 and/ orCPT 4 code or diagnosis code of the complaint forwhich the service was provided
• Trade and/ or generic names and registered Nappicodes of the medicines/ drugs prescribed anddispensed by the health professional
• The quantity and itemized cost of the services,medicines, or drugs
• Agreed Pulamed tariff code of the services that wererendered
• Name and practice number of the referring healthprofessional for the following disciplines - pathologyor laboratory services, medical specialist services,physiotherapy, dieticians, occupational therapy,speech therapy & audiology, clinical psychology, orany other paramedic/allied/associated healthservices, a copy of the letter of referral shall beattached to the invoice
In a case where an invoice refers to the use of an operating theatre, where an operation was performed on the member or a dependent of that member:
• The name and valid practice number ofthe health professional who performedthe operation concerned
• The name or names of the healthprofessional(s) or practitioners whoassisted in such operation
• Invoices must be written in EnglishLanguage. If not, an official and certifiedinterpretation for the particular invoiceshould be provided
• The amount submitted on the bill shouldreflect the total cost of service includingmember co-payments
• A receipt or proof of payment is requiredwhere a member has paid for the medicalservices rendered
NB: The Fund reserves the right to returnall claims not submitted in the prescribedand/or legible format.
Service providers who are KYCnon-compliant will have their paymentswithheld until all KYC documentation is submitted.
Claims submission email –claimsrsa@afa.co.bw or botsquery@afa.co.bw
Claims processing turnaround time – 9 business days
All requests should be e-mailed to claimsrsa@afa.co.bw or botsquery@afa.co.bw
News & Events
Pulamed was proud to participate in the Botswana Life 2nd Annual Employee Benefits Convention 2025 on May 7th 2025, an event that brought together key industry stakeholders to shape the future of employee wellbeing in Botswana.
Our Principal Officer, Dr. Khumoetsile Mapitse, was honoured to serve as a panelist in a high-impact discussion on:
“The Role of the Employer in Driving Employee Wellbeing to Reduce Morbidity, Mortality Rates, and the Prevalence of Non-Communicable Diseases.”
Together, with our partners and stakeholders, we continue to lead in enabling access to healthier living.
Pulamed took part in this year’s National Retail Convention Botswana on May 13th 2025, showcasing our digital health innovations and engagement strategies. Our team connected with key industry leaders on improving health access in retail environments and expanding wellness education to frontline workers.
Our Executive Team attended the 24th Annual Board of Healthcare Funders (BHF) Conference in Cape Town from the 10th – 14th May 2025, where they engaged on reinforcing the power of multidisciplinary collaboration, key ethical and legal issues in healthcare, and member-centric decision making.
What is BHF? The BHF represents medical aid schemes across Southern Africa, advocating for ethical practice, sustainability, and industry improvement.
Every year on 12th May, the world celebrates International Nurses Day (IND), which honors the birth anniversary of Florence Nightingale (1820-1910), who is commonly considered the pioneer of modern nursing. The day honors the critical roles that nurses play in healthcare, soci and the world economy.
On May 16th 2025, Pulamed proudly joined the world in honouring our nurses on International Nurses Day at Bokamoso Private Hospital. We salute their tireless service, resilience, and unwavering commitment.
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