PULA Annual General Meeting Report 2014

ANNUAL GENERAL MEETING REPORT FOR THE FINANCIAL YEAR 2013/2014 12 DECEMBER 2014, AT LANSMORE HOTEL, GABORONE

CONTENTS

Agenda 2 Proxy Form 3 Chairman’s Foreword 5 Board of Trustees 6 Minutes of AGM held on 10 December 2013

8

Board of Trustees Report 10 Annual Financial Statements and Report of the Auditors for the year ended 30 June 2013 (Abridged)

13

Review or Amendment of Fund Rules and Notarial Deed Of Trust

30

PULA MEDICAL AID FUND | ANNUAL GENERAL MEETING REPORT 2013/2014

1

THE 2014 ANNUAL GENERAL MEETING (AGM) OF THE FUND WILL BE

HELD ON 12 DECEMBER 2014, AT LANSMORE HOTEL, GABORONE AT 09:00AM AGENDA 1. Notice convening the meeting 2. Apologies 3. Adoption of the Agenda 4. Chairman’s Opening Remarks 5. Confirmation of the minutes of the previous Annual General Meeting held on 10 December 2013 6. Consideration and adoption of the Report of the Board of Trustees for the year ended 30 June 2014 7. Consideration and adoption of the audited Annual Financial Statements for the year ended 30 June 2014 and the report of the External Auditors 8. Approval of Review or Amendment of Fund Rules and Notarial Deed of Trust 9. Appointment or Re-appointment of Trustees 10. Appointment or Re-Appointment of External Auditors for the ensuing year 11. Any other business 12. Closure A member entitled to attend and vote may appoint a proxy to attend and vote for him on his behalf and such a proxy shall be a member of the Fund. The instrument appointing such a proxy must be deposited at the registered office of the Fund at Plot 61918, Fairgrounds Office Park, Gaborone not less than 24 hours before the meeting. By Order of the Board of Trustees

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PROXY FORM If you cannot attend the Annual General Meeting of the Pula Medical Aid Fund to be held on the 12th December 2014 at 09:00 am at Lansmore Hotel, Gaborone, and you are entitled to vote at the Annual General Meeting, you may appoint a proxy to vote on your behalf. This proxy only applies to the Annual General Meeting, and any adjournment of that meeting.

A. YOUR DETAILS FULL NAMES MEMBERSHIP NO. POSTAL ADDRESS EMAIL

B. WHO DO YOU WANT TO APPOINT AS YOUR PROXY I appoint as my proxy (tick one box only): Chairperson of the Annual General Meeting OR

If you appoint the Chairperson as your proxy, and direct the Chairperson on how to vote, the Chairperson must call a poll on that vote and must vote the way you direct.

The following person

If you want to appoint someone else, give their details. If you do not provide a name, you will be taken to have appointed the Chairperson as your proxy.

FULL NAMES MEMBERSHIP NO. POSTAL ADDRESS EMAIL

DATE:

________________________________

SIGNATURE:

________________________________

*

A proxy nomination shall only be given to a member of the Fund.

*

The instrument appointing the proxy must be deposited at the office of the Administrators of the Fund at the under mentioned address; not later than 24hrs before the time for holding the Annual General Meeting.

AFA House, Plot 61918, Showgrounds Office Park, P O Box 1212, Gaborone, Tel: 365 0500, Fax: 395 1165


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CHAIRMAN’S FOREWORD

During the year under review the Fund continued to consolidate its financial and operational performance, despite keen competition and continued slow recovery of the local and global economies. The Fund will, during the course of the new financial year, embark on interventions that will enable it to respond with agility to on-going market challenges, continually improve service delivery and adding value to all its stakeholders. To this end, the Board of Trustees (BoT) will be requesting members’ approval for a number of amendments to the Fund Rules. In addition, members are urged to continually ensure that their contact details with the Fund are timely updated in order to facilitate easier and direct communication. The Fund has introduced a number of information and communication technology (ICT) platforms to ease claims submission and processing, facilitate member access to their medical aid records, including benefit information and claim payments. Consequently, I would like to take this opportunity to encourage members to use the Fund’s website to easily access such information 24/7. Members may note that increasing healthcare costs continues to be a serious challenge to the sustainability of the Fund. I would like to take this opportunity to encourage prudent utilisation of benefits and rational and ethical selection of healthcare interventions by those qualified to do so. The year under review saw the Fund record a surplus of P20.7million that was 17% higher than that recorded in the prior year. The cumulative surpluses and increased cash and cash equivalents resulted in the Fund’s solvency increasing from 8.7% to 16%. Total assets increased from P43.7 million to P61.4million. Governance As previously reported, key employer groups were requested to nominate representatives to the Board of Trustees. These have all been approved by the Non-Bank Financial Institutions Regulatory Authority (NBFIRA) and took office during the course of the year. In line with the governance instruments of the Fund, members will be requested to re-elect and/or re-appoint those members of the Board whose term of office has or will be expiring as Board of Trustees at the Annual General Meeting. Members are reminded to exercise this right carefully as it may have impact on the running and continued success of the Fund. While NBFIRA is in the process of determining how best to regulate and supervise the Medical Aid Industry

and to come up with a regulatory framework, the Fund continues to be compliant with the requirements of NBFIRA. Conclusion I would like to reiterate to members that the Fund is keenly looking forward to their continued input in improving service delivery. To this end, the Fund will be sending out electronic questionnaires requesting feedback with respect to members’ experiences during their interaction with the Fund and its Administrators. In addition, members are now receiving SMS messages that provide information on how their claims are being paid. Members are encouraged to scrutinise these to ensure that the transactions are legitimate. The Fund will continue to leverage ICT in order to facilitate member participation in the running of the Fund, general communication and improve service delivery. I would like to conclude by thanking all the Trustees and Administrators for their continued commitment and hard work which has positively contributed to the performance of the Fund. I look forward to seeing you all at the 2014 Annual General Meeting (AGM). Yours sincerely,

P D Stevenson Chairman


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BOARD OF TRUSTEES

6

Mr. Peter D. Stevenson CHAIRMAN

Mr. Maleho Mothibatsela VICE CHAIRMAN

Mr Peter D. Stevenson is the current Pula Medical Aid Fund Board of Trustees Chairman. He was appointed to the Board of Trustees prior to the year 2000.

Mr Maleho Mothibatsela is the current Pula Medical Aid Fund Board of Trustees Vice Chairman, serving as an independent member since August 2011.

Mr. Batho Motubudi MEMBER

Ms. Kungo Mabogo MEMBER

Mr Batho Motubudi is a member of the Pula Medical Aid Fund Board of Trustees, serving as an independent member since August 2007.

Ms Kungo Mabogo is a member of the Pula Medical Aid Fund Board of Trustees as an independent member. She was appointed to the Board of Trustees in August 2011.

Dr. Thato Moumakwa MEMBER

Ms. Chandida Thembe MEMBER

Dr Thato Moumakwa has been a member of the Pula Medical Aid Fund Board of Trustees since August 2008. He serves in the Board as an independent member.

Ms Chandida Thembe is a member of the Pula Medical Aid Fund Board of Trustees representing Civil Aviation Authority of Botswana (CAAB). She was appointed to the Board of Trustees in July 2013.


Ms. Mukani Pelaelo MEMBER

Mr. Geoffrey Mahlaka MEMBER

Ms Mukani Pelaelo is a member of the Pula Medical Aid Fund Board of Trustees representing Botswana Unified Revenue Services (BURS). She was appointed to the Board of Trustees in June 2011.

Mr Geoffrey Mahlaka is a member of the Pula Medical Aid Fund Board of Trustees representing Botswana Ash (Pty) Ltd. He was appointed to the Board of Trustees in July 2013.

Dr. Bakani Thipe MEMBER

Mr. Obakeng Moroka MEMBER

Dr Bakani Thipe is a member of the Pula Medical Aid Fund Board of Trustees representing Tati Nickel Mining Company. He was appointed to the Board of Trustees in June 2011.

Mr Obakeng Moroka is a member of the Pula Medical Aid Fund Board of Trustees representing Debswana Diamond Company. He was appointed to the Board of Trustees in July 2013.

MS. GRace SIAMSANG ALTERNATE

DR. PATSON MAZONDE ALTERNATE

Ms Grace Siamisang is an alternate member to Ms Mukani Pelaelo representing Botswana Unified Revenue Services (BURS). She was appointed to the Board of Trustees in June 2011.

Dr Patson Mazonde is an alternate member to Mr Maleho Mothibatsela. He was appointed to the Board of Trustees in December 2011.

MR. OTENG SEBONEgo ALTERNATE Mr Oteng Sebonego is an alternate member to Mr Batho Motubudi. He was appointed to the Board of Trustees in December 2011.


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MINUTES OF THE ANNUAL GENERAL MEETING OF THE MEMBERS, HELD ON 10 DECEMBER 2013, AT 08:38, AT CRESTA LODGE, GABORONE 1. PRESENT: 1.1 Board of Trustees P D Stevenson B Motubudi B Thipe K Mabogo 1.2 General Membership There were 30 members who attended in person and 103 proxies. A total of 123 proxies had been received however 20 were spoilt. 2. IN ATTENDANCE: 2.1 Administrators - AFA Botswana (Pty) Ltd D Thela M Matome J Buno L Keloneilwe (Recording) 2.1 External Auditors PricewaterhouseCoopers (PwC): S Edirisinghe S Vithanage The meeting was called to order at 08:38. 4. NOTICE AND CONSTITUTION OF THE MEETING The notice of the meeting having been duly circulated was taken as read and approved, following a proposal by Ms Van nie Kerk, seconded by Mr M Ncoangae. A quorum being present, the Chairman declared the meeting duly constituted. 4. APOLOGIES FOR NON ATTENDANCE There were no apologies received. 5. ADOPTION OF THE AGENDA The agenda was adopted as circulated following a proposal by Ms Van nie Kerk, seconded by Mr M Ncoangae. 6. CHAIRMAN’S OPENING REMARKS The Chairman welcomed all present to the meeting and thanked them for their attendance. 7. CONFIRMATION OF THE MINUTES OF THE ANNUAL GENERAL MEETING (AGM) HELD ON 5 JULY 2013 The minutes of the AGM held on 5 July 2013 having been duly circulated were taken as read. On a proposal by Ms Van nie Kerk, seconded by Mr S Senwelo, the minutes were adopted and approved as a true and correct record of the proceedings. 8. MATTERS ARISING FROM THE MINUTES OF THE ANNUAL GENERAL MEETING (AGM) HELD ON 5 JULY 2013 There were no matters arising from the minutes of the meeting held on 5 July 2013.

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9. RECEIPT AND ADOPTION OF THE BOARD OF TRUSTEES REPORT TO THE MEMBERS FOR THE FINANCIAL YEAR ENDED 30 JUNE 2013 The meeting was referred to the Report to the members for the year ended 30 June 2013, contained on page 11 of the 2012/2013 AGM Report. The Report had been circulated with the notice for the AGM, and was accordingly taken as read. The Chairman asked the members if they had any comments or questions on the report. There being no comments or questions the report was noted and taken as read and adopted by the members. It was RESOLVED that the Board of Trustees report to members for the year ended 30 June 2013 be and is hereby adopted on proposal by Ms Van nie Kerk and seconded by Mr S Hlope. 10. RECEIPT AND ADOPTION OF THE FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 2013 The members were referred to the Audited Financial Statements for the year ended 30 June 2013 on page 15 of the Report. The Chairman asked the members if they had any comments or questions on the financial statements. There being no comments or questions the financial statements were adopted. It was RESOLVED that the Financial Statements for the year ended 30 June 2013 be and are hereby adopted on proposal by Mr M Isaacs and seconded by Ms G Moagi. 11. APPOINTMENT OF EXTERNAL AUDITORS PricewaterhouseCoopers (PwC) were appointed the external auditor of the Fund for the financial year 2012/2013 and to hold office from the conclusion of the AGM held on 5 July 2013 until conclusion of the next AGM. It was reported that the Auditors had been appointed to hold office until the next AGM. It was RESOLVED that the re-appointment of the external auditors until the next AGM be and is hereby ratified on proposal by Ms Van nie Kerk, seconded by Mr M Ncoangae. 12. DATE OF NEXT MEETING It was reported that the date of next meeting to be in November 2014, would be communicated to the members. 13. ANY OTHER BUSINESS The Chairman asked the members if there was any other business they wished to discuss and there was no response from the members. 14. ADJOURNMENT There being no other business to discuss, the Chairman declared the meeting closed at 08:45. Verified and Signed by the Chairman on this

day of

2014

Peter D. Stevenson


9

BOARD OF TRUSTEES REPORT TO THE MEMBERS FOR THE FINANCIAL YEAR ENDED 30 JUNE 2014 1. INTRODUCTION On behalf of the Board of Trustees (Board) I would like to present the 23rd Annual Report to the members. The report covers the operational and financial performance of the Fund as well as issues around healthcare access facilitation and service. 2. FACILITATING ACCESS TO PRIVATE HEALTH CARE SERVICES The Fund continued to facilitate access to private health care services for its members and their beneficiaries, thus fulfilling its principal mandate and obligation to members and their beneficiaries. Membership grew by 3.6% to 17 540, whilst beneficiaries (members and their dependants) stood at 40 441 lives covered, as at June 2014. On average the Fund’s beneficiaries accessed hospital services at a rate of 2.7 visits per average beneficiary per annum. Hospital services cost were P74.2m for the year under review, 9.8% above costs (P67.6m) for the prior year. At the same time the Fund beneficiaries consulted (visited) general medical practitioners (GP) at a rate of 2.1 consultations per average beneficiary per annum resulting in a payment of P22.1m during the year. The said pay-out was 22.4% above the P18.0m paid out in the previous year. Hospital visits were influenced by the fact that most members reside in the mining towns of Orapa and Jwaneng and hence access services through the mine hospitals, as well as the fact that some of the hospital consultation and procedures may include radiology and laboratory services. Figure 1, below, shows the trend with respect to the Fund’s facilitation of access to private healthcare services for its beneficiaries. Figure 1: Analysis of beneficiary access to healthcare services

The number of beneficiaries facilitated access to hospital, general medical practitioner and pharmacy services increased by 6.2%, 8.4% and 14.6%, respectively, year-on-year. The three (3) categories represented 65% of the Fund’s claims costs for 2013/14. During the year there was a reduction in the use of optometry and radiology services of 15.6% and 10.2% respectively. The former was due to the fact that most members had utilised their optometry benefits in the prior year whilst the latter was due to same services being provided as part of the hospital services as opposed to through standalone radiology facilities. The figure below shows some of the results and achievements as a result of the Fund having facilitated access to private healthcare by its beneficiaries.

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Figure 2: Achievements through healthcare access facilitation

The Fund has assisted members and their beneficiaries defray cost of private healthcare services with1 856 and 2 082 patients actively receiving antiretroviral therapy (ART) and non-ART chronic medicines, respectively. In the area of maternity care, mothers have been facilitated to receive antenatal care including 858 antenatal scans. Of the total deliveries of 531, 293 mothers delivered through Caesarean section and 238 through normal delivery. In support of the national health policy the Fund provides cover for Safe Male Circumcision (SMC) as an HIV preventive intervention. In this regard 27 SMCs were facilitated during the year under review compared with 53 SMCs in the previous year. 3. OVERVIEW OF THE FINANCIAL PERFORMANCE OF THE FUND Figure 3: Overview of Financial Performance The figure above shows that the Fund received gross contribution income of P214.6m, paid benefits of P177.7mand incurred administration expenses of P17.7m that resulted in a net surplus of P20.7m, after taking into account

other income. Gross contribution income and benefits paid grew by 14.6% and 13.1%, respectively. The former was due to contribution increases effected 01 July 2013 and membership growth. The latter was due to service tariff increases effected during the year and increased benefit utilisation by beneficiaries and resulted in the claims ratio increasing from 79% to 80% . The solvency margin increased from 8.37% to 16% as at June 2014, whilst total assets increased from P43.7m to P61.4m. The increased solvency margin resulted from increased in cash balances and the net surpluserecorded. PULA MEDICAL AID FUND | ANNUAL GENERAL MEETING REPORT 2013/2014

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4. OVERVIEW OF OPERATIONS 4.1. LEVERAGING INFORMATION AND COMMUNICATION TECHNOLOGY (ICT) The Fund continues to leverage ICT and has developed facilities to enable electronic claims submission in order to improve service delivery to both members and service providers. The result has been shorter turnaround time and relatively query free claims payment for those service providers who have taken advantage of the functionality. Members will be aware of the introduction of SMS communication post claims payment. The Board urges members to update their contact details (including mobile phone and e-mail) with the Fund to ensure that members are continually informed as and when payments are made by the Fund on their behalf and/or when any significant event occurs. Once again members and service providers are requested to make use of the website facility to update their details, view claims payment, benefit balances, logging of queries, print statements and obtain useful information about the Fund. This can all be done at one’s own convenience 24/7. The Fund will be embarking on routine electronic customer surveys throughout the year in order to get feedback from members and service providers with a view to continually improving its operations and services. Consequently members and service providers are urged to timely respond to the subject questionnaires in order to assist the Fund improve services. 4.2. CLAIMS PROCESSING The Fund processed and paid on average 26 701 claims per month, of which 16.9% were submitted electronically. The volume of claims submitted electronically is expected to increase significantly during the next financial year with our target having more than 80% of all claims submitted being submitted electronically in the near future. 5. OTHER MATTERS 5.1. RULES REVIEW Members will be requested to consider and approve certain Fund Rule changes during the AGM, after which same would be implemented by 01 July 2015 and/or soon thereafter depending on the requirements for such implementation. 5.2. APPOINTMENT OF PRINCIPAL OFFICER (PO) The Board of Directors have appointed a PO in line with the Fund Rules and in anticipation of the Regulator’s requirements. The Non-Bank Financial Institutions Authority (NBFIRA), the Regulator, has indicated that it would be desirable for the medical aid organisations in Botswana to employ Principal Officers. The recruitment process is quite advanced and the PO would be appointed during 2014/15. CONCLUSION The Fund performed satisfactorily financially and operationally during the year under review and the Board anticipates a similar trend going into the future despite keen competition and increasing healthcare cost challenges.

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PULA MEDICAL AID FUND ANNUAL FINANCIAL STATEMENTS for the year ended 30 June 2014 GENERAL INFORMATION for the year ended 30 June 2014 BOARD OF TRUSTEES Board of Trustees as at 30 June 2014 are as follows: Peter D. Stevenson - Chairperson Maleho Mothibatsela - Vice Chairperson Thato Moumakwa - Independent Trustee Batho Motubudi - Independent Trustee Kungo Mabogo - Independent Trustee Bakani Thipe - Employer Group Representative Mukani Pelaelo

-

Employer Group Representative

Geoffrey Mahlaka

-

Representing Botswana Ash

Chandida Thembe

-

Representing Civil Aviation Authority of Botswana (CAAB)

Obakeng Moroka

-

Representing Debswana Diamond Company

Alternates Grace Siamisang

-

Employer Group Representative -

Alternate to Mukani Pelaelo

Oteng Sebonego

-

Independent Trustee

-

Alternate to Batho Motubudi

Patson Mazonde

-

Independent Trustee

-

Alternate to Thato Moumakwa

ADMINISTRATORS Associated Fund Administrators Botswana (Proprietary) Limited P O Box 1212, Gaborone, Botswana. REGISTRATION The Fund was registered in Botswana under the Notarial Deed of Trust (registration reference MA 22/91). PRINCIPAL ACTIVITY The Fund provides assistance to its members and their dependents in defraying expenditure incurred in relation to medical and related services. BUSINESS ADDRESS P O Box 1212, Gaborone, Botswana.


13

GENERAL INFORMATION for the year ended 30 June 2014 REGISTERED OFFICES AFA House, Plot 61918, Showgrounds Office Park, Gaborone. AUDITORS PricewaterhouseCoopers BANKERS First National Bank Botswana Limited BancABC Bank Gaborone Limited ASSET MANAGERS African Alliance Botswana Management Company (Pty) Ltd LAWYERS Armstrongs- Attorneys, Notaries & Conveyancers

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ABRIDGED ANNUAL FINANCIAL STATEMENTS for the year ended 30 June 2014 Contents Page Statement of responsibility by the Board of Trustees and approval of the abridged Annual financial statements 16 Statement of the independent auditor 17 Statement of comprehensive income 18 Statement of financial position 19 Statement of changes in reserves 20 Statement of cash flows 21 Significant accounting policies 22 Notes to the financial statements 25


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ABRIDGED ANNUAL FINANCIAL STATEMENTS for the year ended 30 June 2014

STATEMENT OF RESPONSIBILITY BY THE BOARD OF TRUSTEES The Board of Trustees is responsible for the preparation of the abridged financial statements in accordance with International Financial Reporting Standards. The Board of Trustees acknowledges that it is ultimately responsible for the system of internal financial control established by the Fund and places considerable importance on maintaining a strong control environment. To enable the Board to meet these responsibilities, the Board sets standards for internal control aimed at reducing the risk of error or loss in a cost effective manner. The standards include the proper delegation of responsibilities within a clearly defined framework, effective accounting procedures and adequate segregation of duties to ensure an acceptable level of risk. These controls are monitored throughout the Fund and all employees of the administrator company are required to maintain the highest ethical standards in ensuring the Fund’s business is conducted in a manner that in all reasonable circumstances is above reproach. The focus of risk management in the Fund is on identifying, assessing, managing and monitoring all known forms of risk across the Fund. While operating risk cannot be fully eliminated, the Fund endeavours to minimise it by ensuring that appropriate infrastructure, controls, systems and ethical behaviour are applied and managed within predetermined procedures and constraints. Nothing has come to the attention of the Board to indicate that any material breakdown in the functioning of these controls, procedures and systems has occurred during the year under review. The Board of Trustees is of the opinion, based on the information and explanations given by the administrators, that the system of internal control provides reasonable assurance that the financial records may be relied on for the preparation of the financial statements. However, any system of internal financial control can provide only reasonable, and not absolute, assurance against material misstatement or loss. The going concern assumption has been applied, in the preparation of the financial statements. The Board of Trustees has no reason to believe that the Fund will not be a going concern in the foreseeable future based on forecasts and available cash resources. BOARD OF TRUSTEES’ APPROVAL OF THE ABRIDGED ANNUAL FINANCIAL STATEMENTS Against this background, the Board of Trustees accepts responsibility for the abridged financial statements on pages 6 to 19 which were approved on ______________and are signed on its behalf by:

CHAIRPERSON TRUSTEE

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STATEMENT OF THE INDEPENDENT AUDITOR TO THE MEMBERS OF PULA MEDICAL AID FUND The abridged financial statements on pages 13 to 29 is an extract of the audited financial statements for the year ended 30 June 2014 and contains a summary of significant information, which the Board of Trustees believe are relevant and appropriate for the purpose of the Annual General Meeting of Pula Medical Aid Fund. Our audit opinion issued in respect of the annual audited financial statements for the year ended 30 June 2014, which is unqualified has been included in the full set of the annual financial statements which is available on the Pula Medical Aid Fund’s website.

PricewaterhouseCoopers Gaborone Individual practicing member: A.S. Edirisinghe Membership number: 20030048

PricewaterhouseCoopers, Plot 50371, Fairground Office Park, Gaborone, P O Box 294, Gaborone, Botswana T: (267) 395 2011, F: (267) 397 3901, www.pwc.com/bw Country Senior Partner: B D Phirie Partners:

R Binedell, R P De Silva, A S Edirisinghe


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STATEMENT OF COMPREHENSIVE INCOME for the year ended 30 June 2014 In Botswana Pula

Notes

2014

2013

214,593,910

187,271,604

(177,653,260)

(157,070,852)

Net contribution surplus

36,940,650

30,200,752

Other income

239,167

13,000

(17,739,295)

(12,985,163)

19,440,522

17,228,589

1,394,674

915,991

Income from contributions Benefits paid

Administrative expenses

2

2

Operating surplus Finance income

3

Finance costs

3

(175,262)

(1,258,391)

1,219,412

(342,400)

-

230,022

Surplus for the year

20,659,934

17,116,211

Other comprehensive income

-

-

Total comprehensive income for the year

20,659,934

17,116,211

Net finance income / (costs) Reversal of impairment loss on loan given to associate company 5

18


STATEMENT OF FINANCIAL POSITION for the year ended 30 June 2014 In Botswana Pula

Notes

2014

2013

ASSETS Current assets Available-for-sale financial assets

6

75,036

15,449,924

Trade and other receivables

7

4,083,478

3,636,605

Cash and cash equivalents

8

57,192,410

24,573,891

61,350,924

43,660,420

36,335,933

15,675,999

9

-

22,575

9

-

9,006,021

Provision for outstanding claims

10

20,496,364

15,887,068

Trade and other payables

11

4,518,627

3,068,757

25,014,991

27,961,846

61,350,924

43,660,420

Total assets

RESERVES AND LIABILITIES Reserves Accumulated surplus Non-current liabilities Borrowings Current liabilities Borrowings

Total reserves and liabilities


19

STATEMENT OF CHANGES IN RESERVES for the year ended 30 June 2014 In Botswana Pula

Notes

Accumulated Surplus

Total Reserves

(1,440,212)

(1,440,212)


17,116,211

17,116,211

Total comprehensive income

17,116,211

17,116,211

Balance as at 30 June 2013

15,675,999

15,675,999

15,675,999

15,675,999


20,659,934

20,659,934

Total comprehensive income

20,659,934

20,659,934

Balance as at 30 June 2014

36,335,933

36,335,933

For the year ended 30 June 2013 Balance as at 01 July 2012 Comprehensive income

For the year ended 30 June 2014 Balance as at 01 July 2013 Comprehensive income

20


STATEMENT OF CASH FLOWS for the year ended 30 June 2014 In Botswana Pula

Notes

2014

2013

12.1

215,190,228

189,241,893

Cash paid for claims and other benefits

12.2

(173,131,701)

(156,407,850)

Cash paid in respect of administrative expenses

12.3

(17,005,712)

(11,267,885)

25,052,815

21,566,158

(175,262)

(1,258,391)

24,877,553

20,307,767

Cash flows from operating activities Cash receipts from members

Cash generated from operations 3

Interest paid Net cash flows from operating activities Cash flows from investing activities Interest received on bank call accounts

3

136,061

194,273

Interest received on other investments

3

1,258,613

721,718

Loan repayments received from associate

5

-

4,230,022

-

(711,476)

Investment in available-for-sale financial assets

15,374,888

-

16,769,562

4,434,537

Capital repayments of long term liabilities

(9,028,596)

(5,237,481)

Net cash flows from financing activities

(9,028,596)

(5,237,481)

Net change in cash and cash equivalents

32,618,519

19,504,823

Disposal of available-for-sale financial assets

6

Net cash flows from investing activities Cash flows from financing activities

Cash and cash equivalents at beginning of the year

8

24,573,891

5,069,068

Cash and cash equivalents at end of the year

8

57,192,410

24,573,891


21

PULA MEDICAL AID FUND SIGNIFICANT ACCOUNTING POLICIES for the year ended 30 June 2014 GENERAL INFORMATION Important Notice For the comprehensive notes to the annual financial statements as well as the accounting policies, please refer to www.pulamed.co.bw

PRINCIPAL ACCOUNTING POLICIES The principal accounting policies adopted in the preparation of these financial statements, which have been applied on a consistent basis with those of the previous year, are set out below. 1. Basis of preparation The abridged annual financial statements have been prepared in accordance with International Financial Reporting Standards. The financial statements have been prepared under the historical cost convention as modified by the revaluation of financial assets and liabilities held at fair values through profit or loss. The preparation of financial statements requires the use of estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of income and expenses during the reporting period. Although these estimates are based on management’s best knowledge of current events and actions, actual results may differ from those estimates. 1.1 Financial assets 1.1.1 Classification The Fund classifies its financial assets in the following categories: at fair value through profit or loss (comprehensive income statement), loans and receivables, and available-for-sale. The classification depends on the purpose for which the financial assets were acquired. Management determines the classification of its financial assets at initial recognition. a. Financial assets at fair value through profit or loss (comprehensive income statement) Financial assets at fair value through profit or loss are financial assets held for trading. A financial asset is classified in this category if acquired principally for the purpose of selling in the short-term. Derivatives are also categorised as held for trading unless they are designated as hedges. Assets in this category are classified as current assets. b. Loans and receivables Loans and receivables are non-derivative financial assets with fixed or determinable payments that are not quoted in an active market. They are included in current assets, except for maturities greater than 12 months after the reporting date. These are classified as non-current assets. The Fund’s loans and receivables comprise ‘ loans and advances’, ‘trade receivables’, ‘ other receivables’ and Cash at bank and cash equivalents in the statement of financial position (Notes 5, 7 and 8).

c. Available-for-sale financial assets Available-for-sale financial assets are non-derivatives that are either designated in this category or not classified in any of the other categories. They are included in non-current assets unless management intends to dispose of the investment within 12 months of the reporting date.

22


1.1.2 Recognition and measurement Regular purchases and sales of financial assets are recognised on the trade date, the date on which the Fund commits to purchase or sell the asset. Investments are initially recognised at fair value plus transaction costs for all financial assets not carried at fair value through statement of comprehensive income. Financial assets carried at fair value through statement of comprehensive income are initially recognised at fair value and transaction costs are expensed in the statement of comprehensive income. Financial assets are derecognised when the rights to receive cash flows from the investments have expired or have been transferred and the Fund has transferred substantially all risks and rewards of ownership. Available-for-sale financial assets and financial assets at fair value through statement of comprehensive income are subsequently carried at fair value. Loans and receivables are carried at amortised cost using the effective interest method. Gains or losses arising from changes in the fair value of the ‘financial assets at fair value through profit or loss’ category are presented in the statement of comprehensive income within ‘investment income’ in the period in which they arise. Changes in fair value of monetary and non-monetary securities classified as available-for-sale are recognised in statement of changes in reserves. 1.1.3 Offsetting financial instruments Financial assets and liabilities are offset and the net amount reported in the statement of financial position when there is a legally enforceable right to offset the recognised amounts and there is an intention to settle on a net basis, or realise the asset and settle the liability simultaneously. 1.2 Impairment The carrying amounts of the Fund’s assets are reviewed at each reporting date to determine whether there is any indication of impairment. If any such indication exists, the asset’s recoverable amount is estimated. An impairment loss is recognised whenever the carrying amount of an asset exceeds its recoverable amount. Impairment losses are recognised in the statement of comprehensive income. The impairments of financial assets are done in accordance with financial assets recognition and measurement criteria. An impairment loss is reversed if there has been a change in the estimates used to determine the recoverable amount. An impairment loss is reversed only to the extent that the asset’s carrying amount does not exceed the carrying amount that would have been determined if no impairment loss had been recognised. 1.3 Revenue recognition 1.3.1 Income from contributions The Fund obtains monthly contributions from its members. These contributions are recognised in the statement of comprehensive income on an accrual basis. The premiums include adjustments to premiums from backdated termination and registrations. 1.3.2 Investment income Investment income comprises interest receivable on funds invested, realised investment value and dividend income from investments. Interest income is recognised in the statement of comprehensive income, using the effective interest rate method, and taking into account the expected timing and amount of cash flows. Interest income includes the amortisation of any discounts or premiums or other difference between the initial carrying amount of an interest-bearing instrument and its amount at maturity, calculated on an effective interest rate method. Dividend income is recognised in the statement of comprehensive income when the right to receive payment is established. The accumulated fair value adjustments of available-for-sale investments are included in the income statement as gains and losses from investment securities, at the time of disposal. 1.4 Claims incurred Claims incurred consist of claims paid during the financial year together with the movement in the provision for outstanding claims. The provision for outstanding claims comprises the Fund’s estimate of the cost of settling all claims incurred but unpaid at the reporting date. Whilst the Trustees consider that gross provisions for claims are fairly stated on the basis of the information currently available to them, the ultimate liability will vary as a result of subsequent information and events and may result in significant adjustments to the amounts provided. PULA MEDICAL AID FUND | ANNUAL GENERAL MEETING REPORT 2013/2014

23

Adjustments to the amounts of claims provisions established in prior years are reflected in the financial statements for the period in which the adjustments are made. The methods used to value these provisions, and the estimates made, are reviewed regularly.

1.5 Current income tax The normal Botswana taxation provision has not been made as the Fund is registered under a Notarial Deed of Trust and according to part 1, paragraph (v) of the second schedule of the Income Tax Act,1995, the Trust is exempt from income tax. 1.6 Borrowings Borrowings are recognised initially at the proceeds received, net of transaction costs incurred. Borrowings are subsequently stated at amortised cost using the effective yield method. Any difference between proceeds (net of transaction cost) and the redemption value is recognised in the statement of comprehensive income over the period of the borrowings. 1.7 Provisions Provisions are recognised when the Fund has a present legal or constructive obligation as a result of past events, it is probable that an outflow of resources embodying economic benefits will be required to settle the obligation, and a reliable estimate of the amount of the obligation can be made. Provision is made for estimated outstanding claims incurred during the financial year, which are payable in the succeeding financial year.

1.8 Associates Associates are all entities over which the Fund has significant influence but not control, generally accompanying a shareholding of between 20% and 50% of the voting rights. Investments in associates are accounted for using the equity method of accounting. Under the equity method, the investment is initially recognised at cost, and the carrying amount is increased or decreased to recognise the investor’s share of the profit or loss of the investee after the date of acquisition. If the ownership interest in an associate is reduced but significant influence is retained, only a proportionate share of the amounts previously recognised in statement of changes in reserves is reclassified to statement of comprehensive income where appropriate. The Fund’s share of post-acquisition profit or loss is recognised in the statement of changes in reserves, and its share of post-acquisition movements in reserves is recognised in statement of changes in reserves with a corresponding adjustment to the carrying amount of the investment. When the Fund’s share of losses in an associate equals or exceeds its interest in the associate, including any other unsecured receivables, the Fund does not recognise further losses, unless it has incurred legal or constructive obligations or made payments on behalf of the associate. The Fund determines at each reporting date whether there is any objective evidence that the investment in the associate is impaired. If this is the case, the Fund calculates the amount of impairment as the difference between the recoverable amount of the associate and its carrying value and recognises the amount adjacent to ‘share of profit/(loss) of an associate’ in the statement of comprehensive income. Profits and losses resulting from upstream and downstream transactions between the Fund and its associate are recognised in the Fund’s financial statements only to the extent of unrelated investor’s interests in the associates. Unrealised losses are eliminated unless the transaction provides evidence of an impairment of the asset transferred. Accounting policies of associates have been changed where necessary to ensure consistency with the policies adopted by the Fund. Dilution gains and losses arising in investments in associates are recognised in the statement of comprehensive income.

24


NOTES TO THE ABRIDGED FINANCIAL STATEMENTS for the year ended 30 June 2014 In Botswana Pula 2

2013

177,653,260

157,070,852

Analysis of expenses by nature Claims and other member benefits paid

1,036,963

596,918

13,746,928

12,237,466

Audit fees

232,362

137,897

Consultancy fees

191,128

10,248

Actuarial consultancy fees Administration fees

98,900

76,500

784,605

538,446

Promotions and advertising

1,274,871

761,918

Provision for impairment of debtors

(425,000)

(1,730,819)

Fidelity insurance Other administrative expenses

798,538

356,589

17,739,295

12,985,163

195,392,555

170,056,015

1,258,613

721,718

136,061

194,273

1,394,674

915,991

Interest expense on bank borrowings

(175,262)

(1,258,391)

Net finance income / (costs)

1,219,412

(342,400)

Trustees’ fees Total administrative expenses Total expenses 3

2014

Finance income and costs Finance income Interest income on available-for-sale financial assets Interest income on short-term bank deposits

Finance costs

4

Income tax In terms of part 1, paragraph (v) of the second schedule of the Income Tax Act, the Fund qualifies as an approved benefit fund and consequently is exempt from income tax.


25


2014

2013

Balance at beginning of the year

-

4,000,000

Reversal of impairment loss

-

230,022

Repayments during the year

-

(4,230,022)

Balance at end of the year

-

-

Loans and advances

The loan given to Bokamoso Private Hospital Trust ("the Trust") relates to a guarantee provided by the Fund to the Trust's bankers in respect of bank facilities extended to the Trust. The bank called upon the Fund to make settlement against its guarantee, upon the Trust being placed on sequestration. This loan is unsecured and bears no interest. During 2011, the Trust was placed under sequestration, where no recovery of the loan was expected. As a result, the loan was fully impaired during 2011. Based on commitments made by the sequestrators, the estimated recoverable amount of P 4,000,000 was recognised during 2012 and a further P 230,022 recognised during 2013 based on the final settlement received during the year. 6

Available-for-sale financial assets Balance at beginning of the year Disposals Interests reinvested-African Alliance Liquidity Fund Balance at end of the year

15,449,924

14,738,448

(15,374,888)

-

-

711,476

75,036

15,449,924

75,036

15,449,924

The investments are made up as follows: African Alliance Liquidity Fund

The carrying value of available-for-sale financial assets at the reporting date represents their fair value and represents investment in money market funds that earn market related interest. The maximum exposure to credit risk at the reporting date is the carrying value of the investment. None of these financial assets are either past due or impaired.

26



2014

2013

Contributions receivable

3,964,795

4,561,113

Less: Provision for impairment

(567,568)

(992,568)

3,397,227

3,568,545

6,375

6,375

679,876

61,685

4,083,478

3,636,605

Trade and other receivables

Prepayments Sundry receivables

Contribution debtors are stated at amortised cost less provision for impairment. The impairment loss represents the Board of Trustees' best estimate of the contributions raised and not likely to be recovered. Movement of the provision for impairment of trade receivables are as follows; 992,568

2,723,387

(425,000)

(1,730,819)

567,568

992,568

61-90 days

382,812

606,833

More than 90 days

184,756

385,735

567,568

992,568

3,397,227

3,568,545

Balance at beginning of the year Provision for impairment Balance at end of the year The ageing of the impaired receivables is as follows:

The fair value of trade and other receivables are as follows: Trade receivables Sundry receivables

8

679,876

61,685

4,077,103

3,630,230

57,223,623

24,678,846

(31,213)

(104,955)

57,192,410

24,573,891

Cash and cash equivalents Cash at bank Bank overdraft

Surplus funds are retained in both the current account and the call account. The call account bears interest at current commercial bank rates. As there is a right of set-off, the settlement accounts are included in cash and cash equivalents. The overdraft reflected as of the reporting date represents a temporary book balance which arose pending the transfer of funds from the Fund's call account under its standing sweeping facility with the bank.


27

NOTES TO THE ABRIDGED FINANCIAL STATEMENTS for the year ended 30 June 2014 8 Cash and cash equivalents (continued) In Botswana Pula

2014

2013

57,223,623

24,678,846

For the purpose of statement of cash flows, cash and cash equivalents comprise of: Cash at bank

(31,213)

(104,955)

57,192,410

24,573,891

-

22,575

Bank borrowings

-

9,006,021

Total borrowings

-

9,028,596

Bank overdraft

9

Borrowings Borrowings falling due after 1 year Bank borrowings Borrowings falling due within 1 year

Bank borrowings relate to an unsecured loan of P 16,000,000 obtained from First National Bank of Botswana Limited and is repayable in 120 instalments commencing January 2011. The carrying amount of borrowings represent their fair value as they are obtained at market related rates. 10

Provision for outstanding claims Balance at beginning of the year Increase in claims provision Balance at end of the year

15,887,068

13,603,354

4,609,296

2,283,714

20,496,364

15,887,068

The provision for outstanding claims represents the Trustees’ best estimate of claims, with the assistance of actuaries, that have been incurred during the current financial year but which are payable after the year-end. The following are key assumptions used in the computation of claims which were incurred but not reported (IBNR) as at 30 June 2014.

Membership growth Inflation rate Investment return Assumed bad debts Contribution increase

28

- - - - -

Standard option 5% per annum and De-luxe option 6% per annum 8% per annum 0.3% per month 0.5% per annum 5% per annum



2014

2013

-

87,737

Administration fees payable

1,832,438

1,538,286

Other accounts payables

2,686,189

1,442,734

4,518,627

3,068,757

Trade and other payables Creditor for claims

Creditors for claims represents claims that have been processed and approved for payment but have not yet been paid at the reporting date. The fair values of accounts payable balances approximate their carrying amounts due to their short term nature. 12

Notes to the statement of cash flows

12.1

Cash receipts from members Opening contribution receivables

(Note 7)

Contributions for the year Closing contribution receivables

12.2

(Note 7)

2013

4,561,113

6,531,402

214,593,910

187,271,604

(3,964,795)

(4,561,113)

215,190,228

189,241,893

Cash paid for claims Opening creditor for claims

(Note 11)

Claims expense Other member benefits Closing creditor for claims

12.3

2014

(Note 11)

(87,737)

(1,708,449)

(166,548,542)

(148,750,432)

(6,495,422)

(6,036,706)

-

87,737

(173,131,701)

(156,407,850)

Cash paid in respect of administration expenses Opening accounts payable

(Note 11)

(2,981,020)

(2,324,151)

Opening other receivables

(Note 7)

68,060

2,846,288

Administration expenses

(Note 2)

(17,739,295)

(12,985,163)

239,167

13,000

Decrease in debtors provision

(Note 2)

(425,000)

(1,730,819)

Closing other receivables

(Note 7)

(686,251)

(68,060)

Closing accounts payable

(Note 11)

4,518,627

2,981,020

(17,005,712)

(11,267,885)

Other operating income


29

REVIEW OR AMENDMENT OF FUND RULES AND NOTARIAL DEED OF TRUST To: PULA Members From: Board of Trustees Date: 20 November 2014 Subject: Proposed amendments to Rules In terms of Rule 29 any matters not specifically covered by the rules and/or the Deed of Trust shall be left to the discretion of the Board of Trustees; provided that the decision of the Board of Trustees shall not be inconsistent with the provisions of the Deed of Trust and/or the Rules. The Rules further provide under Rule 44.1 that unless otherwise provided for in the Rules, the Board of Trustees shall be entitled to alter or rescind any Rule or Annexure or to make any additional Rule or Annexure; provided that no alteration, rescission or addition which affects the objects of the Fund, or which increases the rates of contribution or decreases the extent of benefits by more than 25 percent during any financial year shall be valid, unless it has been approved by a majority of members present or represented by proxy at a meeting of members convened in the manner provided for in the Rules. In light of the above, the Board of Trustees proposes the following amendments to the Rules and recommends that the members should pass a resolution to amend the rules accordingly.

RULE AS PER THE RULE BOOK

5.11.3.2 Subject to the approval of the Board of Trustees and on such conditions as it may prescribe, a member’s child who is over the age of 21 years; who is unmarried and owing to mental or physical disability or any similar cause is dependent on the member; is not in receipt of a regular monthly remuneration exceeding the amount prescribed in Annexure A; provided that such person will be recognised as a special dependant for periods of not more than 12 months at a time.

30

PROPOSED AMENDMENT / PROPOSED NEW RULE

REASON FOR PROPOSED AMENDMENT

These Rules shall be governed by the laws of the Republic of Botswana and the courts of the Republic of Botswana shall have jurisdiction.

To state which law governs the Rules.

… amount prescribed in Annexure A; provided that for irreversible conditions such person shall be recognised as a dependant for a period of three (3) years, and for reversible conditions such a person shall be recognised for a period of one (1) year, at a time.

To make it clear at the point of joining the Fund whether illness or disability condition of such dependant is irreversible or not and to reduce frequency of renewal for irreversible conditions.

5.19 “independent board member”- member of the Board of Trustees excluding persons from major employer groups who are already represented in the Board and persons belonging to other medical aid schemes based in Botswana.

To provide for a definition of “Independent board member”.

5.29 A pre-existing condition is defined as any ailment, illness, or condition where, in the opinion of a medical adviser appointed by the Fund, the signs or symptoms of that illness, ailment or condition existed at any time over and/or in the period of 6 months before the person became a member of the Fund. The pre-existing condition waiting period applies to new members.

To clarify and/or define what a Preexisting condition is.


PROPOSED AMENDMENT / PROPOSED NEW RULE


REASON FOR PROPOSED AMENDMENT

5.30.1 “Medical Assistive devices”- For purposes of these Rules; medical assistive devices shall mean, external orthopaedic & surgical prosthesis, Auditory and ophthalmic devices used to replace, compensate for or improve the functional abilities of a member with a disability.

“

prosthesis” shall mean an artificial 5.30 substitute for a missing body part, or any device by which the performance of a natural

5.30.2 “Medical and Surgical appliances” Includes Medical, Surgical and Orthopaedic devices and appliances that are predominantly used externally in disease management or prevention of complications as well as rehabilitation and facilitation of independent living.

To clarify on the different “prosthetic” devices/appliances and allow for clearer differentiation of related benefit limits.

5.30.3 “Prosthesis used in surgery” - Means internal prosthetic devices implanted during an operation for replacement of a body part or for modification of the anatomy or physiological process. 7.3.2 Any applicant who is 50 years of age or older who was not a member of one or more medical schemes at the time of joining the Fund will incur a penalty by way of additional contributions as follows: Years member was not a member of medical aid since the age of 50

Late joiner penalty

1 – 4 years

1.25

5 – 14 years

1.5

15 – 24 years

1.75

25 years +

2

New Rule introducing penalty for late joiners

7.3.1 a person shall not be entitled to pensioner membership unless he has attained the age of 65 years, but the Board of Trustees may make such arrangements to provide for the continued membership at normal contribution rates for a person who proceeds on early retirement.

7.3.2 a person shall not be entitled to pensioner membership unless he has attained the age of 50 years, but the Board of Trustees may make such arrangements to provide for the continued membership at normal contribution rates for a person who proceeds on early retirement.

To reduce age of retirement and align with prevailing qualification for retirement benefits

8.5 Notwithstanding the provisions of Rules 8.2, 8.3 and 8.4 the Fund may implement membership underwriting for a period as may be determined by the Board of Trustees from time to time.

8.5 Notwithstanding the provisions of Rules 8.1, 8.2, 8.3 and 8.4 the Fund may implement membership underwriting for a period as may be determined by the Board of Trustees from time to time.

To allow for underwriting for members who may opt to join the Fund from another medical aid scheme for purposes taking advantage of the Fund.

17.3 The Board of Trustees shall have the right to withdraw or refuse payment of benefits to members whose contributions are more than two (2) months in arrears, and where an account has been paid in accordance with Rule 19, the member shall be liable to repay to the Fund, the full amount.

17.4 The Board of Trustees shall have the right to withdraw, put on suspension or refuse payment of benefits to members whose contributions are more than two (2) months in arrears, and where an account has been paid in accordance with Rule 19, the member shall be liable to repay to the Fund, the full amount.

To provide for suspension instead of withdrawing and/or refusing payment of benefits for persons whose contributions are in arrears.

17.8 The Fund may provide cover for preventative healthcare interventions as may be determined by the Board of Trustees from time to time.

To make provision for preventative healthcare interventions for the benefit of members

20.1 Every claim, submitted to the Fund in respect of the rendering of any service, or the supply of any medicine, requirements, or accommodation in a hospital or nursing home, shall be accompanied by the account or statement, signed by the member or dependant certifying the validity thereof.

20.1 Every claim, submitted to the Fund in respect of the rendering of any service, or the supply of any medicine, requirements, or accommodation in a hospital or nursing home, shall be accompanied by an invoice, signed by the member or dependant certifying the validity thereof.

20.3.7 the nature of the service and diagnosis of the complaint for which the service was provided;…by the health professional; ….

20.3.7 the nature of the service and international classification of disease (ICD) and/or current procedural terminology (CPT) code or diagnosis code…

To replace the word “statement(s)”with “invoice” throughout the Rules as Invoice, not statements must be used for payment of claims.

To provide for use of diagnosis and procedure coding


31


PROPOSED AMENDMENT / PROPOSED NEW RULE 20.3.14 Members should submit invoices written in English Language if not so an official and certified interpretation for that particular invoice should be provided.

REASON FOR PROPOSED AMENDMENT To ensure common understanding of invoices submitted in other languages in order to avoid delays in claims payment.

23.2 Application for Ex-gratia payment should be submitted to the Fund within six (6) months from date of service. The Board Of Trustees may under exceptional circumstances consider ex-gratia payments submitted beyond six (6) months from date of service. Application for Ex-gratia payment may be submitted three (3) times in any financial year provided that the amount per submission is not less than One Thousand (P1,000) Pula.

To ensure the Rules provide for period in which ex-gratia payment should be submitted as well as the frequency of application or limit.

23.1 The Board of Trustees shall make decisions on ex-gratia awards. Should the member not be satisfied with the decision of the Board of Trustees, he/she shall have the right of appeal to the Disputes Committee within 14 days upon receipt of notification.

23.1 The Board of Trustees shall make decisions on ex-gratia awards however the Board of Trustees may delegate the said decision to the Principal Officer and/or any other person so authorised by the Board subject to a criteria as may be decided from time to time. …

To provide more clarity on who should approve Ex-gratia payments and provide authority to delegate.

24.1.2 At least three (3) shall be independent members, with the relevant qualifications, skills and expertise and appointed by the Board of Trustees.

24.1.2 At least three (3) shall be independent members, with the relevant qualifications, skills and expertise to complement those of the major employer group representatives.

To add clarity to the appointment of Independent Board of Trustees.

24.1.3 The term of office shall be limited to three (3) years with a possibility of renewal; provided that no person shall serve on the Board for more than a total of six (6) years.

24.1.3 The term of office shall be limited to five (5) years with a possibility of renewal at each Annual General Meeting; provided that no person shall serve on the Board for more than a total of 10 years.

To allow for a reasonable learning period due to the complexity of the industry and also ensure value addition, appropriate succession planning by the Board and compliance with good corporate governance.

24.1.4 Members of Board of Trustees who are representatives of major employer groups may advertise vacancies in the Board of Trustees in the private media and thereafter nominate eligible candidates for appointment/approval by members at the AGM to fill vacant positions of Independent Members in the Board of Trustees.

To ensure transparency in the process for appointment of independent members.

24.1.5 At each Annual General Meeting, retiring Board members shall be eligible for re-appointment provided that no person shall have served on the Board for more than a total of 10 years.

To ensure transparency and good corporate governance.

24.5 It shall be permissible for a member of the Board to nominate a member of the Fund to act as his alternate on the Board, and subject to the Board’s approval, such nominee shall be appointed as an alternate on the Board for such a member.

24.5 It shall be permissible for a member of the Board to nominate a member of the Fund to act as his alternate on the Board … subject to satisfying the same criteria for appointment of the substantive member.

To ensure that the process for appointment of the substantive member is the same as that of alternate members.

Benefits- 27.7 Paraplegia

The total and irreversible loss of the use of both lower limbs.

To provide more clarity on the definition of paraplegia.

2. BENEFITS EXCLUDED All costs for the treatment of infertility, including artificial insemination of a person (Intro-vitro Fertilisation (IVF).

2. BENEFITS EXCLUDED All costs for the treatment of erectile dysfunction, infertility, including artificial insemination of a person (Intro-vitro Fertilisation (IVF).

To clarify that erectile dysfunction falls under benefits excluded.

Annexure A, 4.3 Income qualification fro specil dependants

4.3 Income qualification fro specil dependants to read as Income qualification for special dependants.

32


To correct typographical error under Clause 4.3

Executive Benefit Options

Limit per family per annum unless otherwise stated M

M+1

M+2

M+3

Annual Overall Limit (=Annual Basic Limit Dread Disease Cover)

2 000 000

Annual Basic Limit

1 300 000

Dread Disease Cover

M+4

M+5+

700 000

% of Tariff Paid

90% for all benefits (10% co-payment applies)

1. Medical Practitioners 1.1 General Practitioners & Medical Specialists, including Psychiatrists 1.1.1 Consultations visits, non-surgical & surgical procedures, operations, anaesthetics and other professional services, including confinements services

Subject to Annual Basic Limit (MRI and CT Scans are subject to preauthorisation)

1.2 Confinement Facility Fees 1.2.1 Normal

10 000 per beneficiary per annum

1.2.2 Caesarean


2. Physiotherapists

Subject to Annual Basic Limit and Upon Referral by a Medical Doctor

3. Dentistry 3.1. Maxilla-facial & Oral Surgery

Subject to Annual Basic Limit and Upon Referral by a Medical Doctor

3.2. Conservative dentistry including plastic based dentures

Subject to Annual Basic Limit

3.3 Limited Dentistry 3.3.1 Inlays, crowns, bridgework, study models, metal base dentures and their repair, periodontics, prosthodontics and orthodontics

15 000 per family per annum

4. Prescribed Medicines and Injection Material 4.1 Overall Medicine Limit

4 000

7 000

8 700

9 500

10 000

4.1.1 Pharmacy Only Medicines (Over the Counter)

1 000

1 800

2 100

2 600

3 000

3 000

4.1.2 Prescription Only Medicines

3 000

5 200

6 600

6 900

7 000

7 000

4.1.3 Injection materials supplied by a medical practitioner, dentists or authorised health professional

10 000

Up to overall medicines limit (4.1)

5. Government and Private Hospitals (in-patients)

Subject to Pre-authorisation and Case Management

5.1 Accommodation (general ward)


5.2 Intensive Care or High Care 5.3 Accommodation (private ward)

Subject to agreed tariff and the Annual Basic Limit

5.4 Recovery Room Fees 5.5 Medicines, materials & apparatus


5.6 Theatre Fees 5.7 Prosthesis used in surgery

60 000 per case

6. Paramedical Services 6.1 Audiology and / or Speech Therapy 6.2 Dietician (Doctor's referral required)

15 000 per family per annum (for a combination of 6.1 to 6.5)

6.3 Clinical Psychology 6.4 Occupational Therapy 6.5 Chiropody 6.6 Ambulance (Inter-hospital transfer only)

4 000 per case

6.7 Blood Transfusion


6.8 Medical Assistive Devices

30 000 per family per annum (subject to pre-authorisation)

6.9 Medical and Surgical Appliances

2 000

6.10 Consulting Nurse (Family Nurse Practitioner)

At a consultation tariff equivalent to half that of a general medical practitioner and subject to Annual Basic Limit

6.11 Step-down Facility / Nursing Homes

2 800

3 400

4 200

4 800

5 600

Maximum of 42 days in a financial year and at agreed tariff


33

Executive Benefit Options 6.12 Home-base Nursing

Limit per family per annum unless otherwise stated 4 000

6.13 Wheel Chair

5 000

5 400

5 800

6 200

6 600

3,500 per beneficiary every three financial years

7. Optical 7.1 Eye Test by Optometrist

At agreed tariff and Subject to Annual Basic Limit

7.2 Orthoptistry

1,600 per beneficiary per annum

7.3 Spectacles and / or Contact Lenses and Contact Lenses Solutions

3 000 per beneficiary per two financial years, frames capped at 1 500

8. Associated Health Services 8.1 Chiropractic

500

900

1 200

1 500

1 700

2 000

8.2 Homeopathic / Naturopathy

500

900

1 200

1 500

1 700

2 000

9. Acupuncture

500

900

1 200

1 500

1 700

2 000

10. Safe Male Circumcision (HIV prevention only)

Per agreed tariff per case Subject to pre-authorisation

11. Surgical Contraception (pre-authorisation required)


12. Specified Conditions (pre-authorisation required) 12.1 Psychiatry Medicines


12.2 Alcoholism and / or Drug Addiction (Rehabilitation)

30 000 per family per annum 20 000 per beneficiary per annum (includes antiretroviral drugs, monitoring tests, CD4+ and viral load)

12.3 HIV / AIDS 12.4 Chronic Medication

20 000 per beneficiary per annum Annual medical examination inclusive of screening tests such as HIV, Pap smear, mammograms etc as may be determine from time to time by the Board of Trustees

13. Preventive Care 14. Funeral Cover

10 000 per main member and adult dependant, 6 000 per child dependant

15. Travel Insurance

2 000 000 per member (family) medical expenses covered for a maximum of 45 out of country excursion days.

General conditions similar to the Deluxe Option are applicable (e.g. proration of benefits, recognised tariffs, dread disease cover definition etc). Amendment to Annexure A: Contribution Table for the Executive Option FY 2014/2015

34

Principal Member (PM)

P 1 456

Adult Dependant (AD)

P 1 005

Child Dependant (CD)

P228



35

AFA HOUSE Plot 61918, Showgrounds Office Park P.O. Box 1212 Gaborone Tel: 365 0500/ 365 0586 Fax: 395 1165

Your Premier Health Partner

Plot 31966, Unit 2 Ground Floor, Baines Avenue P.O. Box 323, Francistown Tel: 241 2290/ 241 2390

PULA Annual General Meeting Report 2014

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