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You are here: Anglovaal Group Medical Scheme  »  Application forms
 Application forms

Adobe Acrobat PDF  Application for out-of-hospital management of a PMB condition (111kb)

Adobe Acrobat PDF  Application to add dependants (503kb)

Adobe Acrobat PDF  Member Application - No underwriting (282kb)

Adobe Acrobat PDF  Member Application - Underwriting (622.65kb)

Adobe Acrobat PDF  Chronic Illness Benefit Application Form (256.83kb)

Adobe Acrobat PDF  Change of banking details for payment of claims application (188kb)

Adobe Acrobat PDF  Continuation form: Change in main member (257kb)

Adobe Acrobat PDF  Declaration of membership (198kb)

Adobe Acrobat PDF  Ex Gratia Application form (24kb)

Adobe Acrobat PDF  HIV PMB Appeal form (27kb)

Adobe Acrobat PDF  HIV Care Programme application form (27kb)

Adobe Acrobat PDF  Information disclosure consent application (303.88kb)

Adobe Acrobat PDF  International claim application (41kb)

Adobe Acrobat PDF  Member withdrawal application (22kb)

Adobe Acrobat PDF  Medical Savings Account exception (44kb)

Adobe Acrobat PDF  Newborn registration application (44kb)

Adobe Acrobat PDF  Out-of-hospital PMB appeal form (147kb)

Adobe Acrobat PDF  Pre Assessment request form (27kb)

Adobe Acrobat PDF  Request for additional cover for PMB CDL conditions (34kb)

Adobe Acrobat PDF  Request for Pre-exposure Prophylaxis form (141kb)

Adobe Acrobat PDF  Request for extended supply of medicine (141kb)

Adobe Acrobat PDF  Reverse claims form (111kb)

Adobe Acrobat PDF  Transfer from active to retiree status application (42kb)

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 Benefit Guides

   Advanced Illness Benefit(265kb)

   Bank details for manual payments(237kb)

   Chronic Illness Benefit medicine list (formulary)(1.4mb)

   Chronic Illness Benefit medicine list (formulary) 2021(1.74mb)

   Cover for pregnancy and childbirth(417kb)

   Dental Protocol(452kb)

   Diabetes Programme(252kb)

   Guide to Prescribed Minimum Benefits(716kb)

   Guide to transplant claims submission process(273kb)

   HIV Antiretroviral (ARV) medicine list (formulary)(280kb)

   HIV Basket of care medicine list (formulary)(261kb)

   HIV Nutritional and mother-to-child prevention medicine list (formulary)(397kb)

   HIV Supportive medicine list (formulary)(505kb)

   HIVCare Programme(313kb)

   Motor Vehicle Accident(256kb)

   Oncology Programme(442kb)

   Optical Benefit(312kb)

   Prescribed Minimum Benefit treatment baskets for CDL(485kb)

   The Screening and Prevention benefit(406kb)

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0860 100 693  |  Operating hours: 07:00 – 17:00 Monday to Friday  |   service@discovery.co.za




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Copyright 2017 Anglovaal Group Medical Scheme | All Rights Reserved. Registration number: 1571.