Application forms
Application for out-of-hospital management of a PMB condition (111kb)
Application to add dependants (503kb)
Member Application - No underwriting (282kb)
Member Application - Underwriting (622.65kb)
Chronic Illness Benefit Application Form (256.83kb)
Change of banking details for payment of claims application (188kb)
Continuation form: Change in main member (257kb)
Declaration of membership (198kb)
Ex Gratia Application form (24kb)
HIV PMB Appeal form (27kb)
HIV Care Programme application form (27kb)
Information disclosure consent application (303.88kb)
International claim application (41kb)
Member withdrawal application (22kb)
Medical Savings Account exception (44kb)
Newborn registration application (44kb)
Out-of-hospital PMB appeal form (147kb)
Pre Assessment request form (27kb)
Request for additional cover for PMB CDL conditions (34kb)
Request for Pre-exposure Prophylaxis form (141kb)
Request for extended supply of medicine (141kb)
Reverse claims form (111kb)
Transfer from active to retiree status application (42kb)
» Acrobat file (to download, right-click and select "save target as" or click to view online)
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)
» Acrobat file (to download, right-click and select "save target as" or click to view online)