DHMPMB001 Discovery Health Medical Scheme, registration number 1125, is regulated by the Council for Medical Schemes and administered by Discovery Health (Pty) Ltd, registration number ⦠It is imperative that a patient meet the criteria as stipulated in the application form when applying for benefits for these conditions. Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Remedi Rate. 3. Registration number: 1430. Up to date forms are always available on www.discovery.co.za under Medical Aid > Find documents ⦠Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Remedi Rate. Download the forms you need to do your medical aid business with Medihelp. Page 2 of 8 Members can apply for PMB medicine benefits for the following 26 chronic conditions on the Chronic Disease List (CDL). Bankmed Medical Scheme. The latest version of the application form is available on www.yourremedi.co.za. Chronic conditions covered are listed per option below. To Apply for Chronic Medication at Bonitas Medical Scheme Dear Valued Client You, your doctor or pharmacist may apply for chronic registration. The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. Page 1 of 5 Remedi Medical Aid Scheme Registration number 1430 This application form is to apply for the Chronic Illness Benefit and is only valid for 2010. Please FAX completed form to: 086 651 8009 Or mail to: PO Box 38632, Pinelands, 7430 Member telephone: 0860 004 367 Provider telephone: 0860 100 608 MEDICINE MANAGEMENT CHRONIC MEDICINE BENEFIT APPLICATION ONLY COMPLETE THIS FORM IF YOU ARE A FULLY REGISTERED MEMBER OF GEMS D D ⦠Please keep in mind that we do not have established contracts with all the medical aids listed below. Log in to start a new session or go to the home page. Page 1 of 7 €09.07.2020 Need an online account? ... You can view your medical aid details, approved chronic conditions and you can track your benefit usage, search for other application forms, your medical aid membership certificate and your tax ⦠There are three product lines that have different coverage listings for medical care under the Remedi Group. The Chronic Medicine Benefit is managed using a clinical pre-authorisation process that is governed by a formulary (a set of drugs) and disease specific guidelines, developed and reviewed by the Health Policy Unit (HPU).. 2020 Chronic medicine application form: 2020 Corporate application form: 2020 Corporate member benefit option change form: ... 2020 Applying to join the DHMS when moving from another medical scheme: 2020 Becoming an employer contact: 2020 Declaration of medical scheme membership: Your doctor needs to complete a Request for additional cover for approved Chronic Disease List conditions form and submit it for review. HIV/AIDS Disease Management Programme registration form: Application for continued medical assistance (Z583 form) Chronic medicine application form: Chronic medicine delivery amendment form: Termination of ⦠If we approve your application for our Chronic Disease Benefit, weâll give you a medicine access card. DETAILS OF MEMBER ... understand that my/my dependantâs participation is subject to my/my dependantâs eligibility under the Medical Aid Fund. Registration number 1578 is administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07. It is imperative that a patient meet the criteria as stipulated in the application form when applying for benefits for these conditions. Three Options from Remedi . M¦ãæGA¡Ét¯Üü¸ôÀTº7ní@¡ÉôoÜüÈ (4ûÊÍÓ³(4þ
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wwÿ]±º®õlë|ÙK5ë'¯ÍqP4Éø3¤ÅH. Medical Scheme Membership Details Update 2020. Please refer to the Prescribed Minimum Benefit treatment baskets document to view what is covered for your approved PMB CDL condition. This card records the medical condition for which weâve approved ⦠Alternatively you can phone 0860 116 116, or your doctor You must complete a Chronic Illness Benefit application form with your doctor and submit it for review. Remedi Medical Aid Scheme (Remedi) is a restricted medical scheme registered and regulated by the Council for Medical Schemes (CMS). There is no medicine list (formulary) for the ADL conditions. CHRONIC MEDICINE PROGRAMME APPLICATION HOW TO FILL IN THIS FORM â The patient or principal member must complete Section 1 in full. Chronic Illness Benefit Application form 2020 ' ' 0 0 < < < < ' ' 0 0 < < < < Please note that this form expires on 31/03/2021. Comprehensive Formulary. Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Remedi Rate. You may have a co-payment for medicine not on the formulary. Our chronic application process is telephonic and in real time. âYour Planâ allows you to view your medical aid details, approved chronic conditions and you can track your benefit usage. Please FAX completed form to: 086 651 8009 Or mail to: PO Box 38632, Pinelands, 7430 Member telephone: 0860 004 367 Provider telephone: 0860 100 608 MEDICINE MANAGEMENT CHRONIC MEDICINE BENEFIT APPLICATION ONLY COMPLETE THIS FORM IF YOU ARE A FULLY REGISTERED MEMBER OF GEMS D D M M Y Y Y Y D M Y Netcare Medical Scheme. The following details are provided for your information only, and should kindly not be returned to Medihelp with your application. The objective is to encourage the best use of the Chronic Medicine Benefit by ensuring: the ⦠The Comprehensive Formulary applies to the more comprehensive medical aid options and provides access to a wider range of medicines, such as ⦠These include the 26 conditions on the Chronic Disease List, according to the Medical Schemes Actâs Prescribed Minimum Benefits*, which ensure access to certain medical treatments for all medical scheme members, ⦠Our mission is to provide cost-effective healthcare benefits that meet your needs, supported by efficient administrative processes ensuring that you have peace of mind regarding major medical ⦠Copyright 2019 Remedi Medical Aid Scheme | All Rights Reserved. Members of Remedi Medical Aid Scheme can register. The three packaged medical aid deals offered by Remedi are the Standard, the Classic, and the Comprehensive. However, if you are travelling overseas and need up to six month’s supply of medicine, please complete a Request for extended supply of medicine and submit it for review. â Sections 2â5 must be fully completed by the doctor to ensure efficient processing. It is important to note that an appeals process does not guarantee an automatic approval for the additional cover. kºx¶¼ÝÕÛ TFG Medical Aid Scheme. If we donât approve your application, weâll give you the reasons why, and you may ask us to review our decision. Once completed please fax application and copies of supporting ⦠Cost-effective medical aid is the further objective of the company. If your PMB CDL condition is approved, the Chronic Illness Benefit will cover a limited number of selected tests, procedures and specialist consultations for the ongoing management of your condition. Application Form - Option A and B Plus 2020. Member to complete section 1 and patient consent and signature section 5 2. All of our options provide cover for the TWENTY NINE conditions included in the Chronic Disease List (CDL), in compliance with the Council of Medical Schemes requirements, with certain ⦠Unexplained anaemia,neutropaenia,chronic thrombocytopenia Extrapulmonary tuberculosis Expected date of C/S D D M M Y Y Y Y Medical Aid No: Dep Code: Patient Name: Page 3 of 4 Application Form Confidential AfA does not dispense medication - Please fax this completed form to 0800 600 773 or email it to ⦠Page 1 of 6 Chronic Illness Benefit application form 2019 Name and surname Date … Forgot username and password? Chronic cover for the 27 CDL (Chronic Disease Lists conditions) is unlimited with no co-payments or levy if the medicine is on the schemeâs formulary and the price of the medicine is equal or less than the reference price for the product. Trouble logging in? Three Options from Remedi . Only complete this form if you are a fully registered member of your medical scheme Telephone 0860 100 608 Please fax completed form where possible to: 0800 223 670 | 680 or mail to PO Box 38632, Pinelands, 7430 d d m m y y y y d d m m y y y y Medicine Management Chronic Medicine Benefit Application AfA PrEP Application form: Application form for HIV- patients requiring PrEP. Chronic Illness Benefit application form 2020 ' ' 0 0 < < < < ' ' 0 0 < < < < NETCIB001 Netcare Medical Scheme, registration number 1584, is administered by Discovery Health (Pty)Ltd, registration number 1997/013480/07, an authorised financial services provider. Patient Consent Form for Telephonic or Internet Registration: Consent form for patients enrolled telephonically, or via direct online processing. Medical Scheme continuation form RW MED. You have further cover for Additional Disease List (ADL) conditions. Mƾqóôl Previously diagnosed patients If you already know what you want, why not make use of our site to download the relevant Medical Aid Application Form and then fax it back to us on 0866 200 320 . For finer details and/or pricing on any of the above Chronic Illness Cover, just fill in our Medical Aid Quote Request form and we will get back to you promptly. Your doctor may follow an appeals process to request for additional funding for medicine, tests, procedures and consultations for your approved PMB CDL condition. You or your doctor may need to provide certain test results or extra information to finalise your application. Please ask your doctor to contact the Customer Care Centre on 0860 002 133 to apply for chronic cover There are three product lines that have different coverage listings for medical care under the Remedi Group. 2. Forgot username and password? Our chronic application process is telephonic and in real time. Completing the chronic medicine application form: Please print using block letters 1. RW Medical AID Communiq'ue ... Rand Water Medical Scheme Forms: 1. A. : PATIENTâS MEDICAL HISTORY: ... Witbank Coalfields Medical Aid Scheme Ntsika Option ... Tiger Brands Medical Scheme Primary Plus Option Transmed Medical Scheme Link Plan Medicines not on the medicine list will be funded up to the Chronic Drug Amount (CDA). Treating doctor to complete section 2,3 4 and doctor declaration and signature section 5 3. Discovery Health (Pty) Ltd is an authorised financial services provider.Page 1 of 7 Chronic Illness Benefit application form 2019 This application form is to apply for the Chronic Illness ⦠Page 1 of 6 Chronic Illness Benefit application form 2019 This application form is to apply for the Chronic Illness Benefit for members on the Essential and Basic Plans The latest version of the application form is available on www.bankmed.co.za. OPMED APPLICATION FORM FOR Chronic Disease List Conditions (CDL) and other Chronic Conditions ATTENDING MEDICAL PRACTICIONER TO KINDLY COMPLETE THE RELEVANT SECTIONS AND RETURN ALL PAGES TO: PO Box 8796, Centurion, 0046, fax to 0866 151 503 or email to opmed@mediscor.co.za NB: Please complete one application form per patient. Step 4: Youâll get your medicine access card. If your doctor uses HealthID, your doctor can apply for cover online, provided you gave your consent. â Fax, email or post the completed and signed application forms ⦠Disclaimer T's & C's This website and the information contained within it is intended for information and consumption purposes only and does not by any means supersede the Rules of the Scheme. You are also able to search for other application forms, your medical aid membership certificate and your tax certificate. To arrange approval for your chronic medicine or to register on the oncology or HIVCare programmes Call: 0860 101 252 For anonymous fraud tip-offs Fraud hotline: 0800 004 500 Extra services Internet queries: 0860 100 696 Smart health choices: 0860 999 911 (for medical advice) To arrange delivery of your chronic medicine ⦠If you want to access cover from the Chronic Illness Benefit, you must apply for it. Approved medicine for these conditions will be funded up to a monthly limit. If you were recently diagnosed with and approved for cover for a PMB CDL condition, the expenses related to the diagnosis of the condition may be funded from the Chronic Illness Benefit and not from other available benefits, provided that you were an active and valid member of the Scheme when the diagnosis of your condition was made. You will need to have the following information on hand: Your membership number The beneficiary’s date of birth The ICD 10 code The doctor’s practice number The medicine details Alternatively you can phone 0860 116 116, or your doctor (To be completed by Member) 1. 2019 Application for registration of dependants form: 2019 Application for registration of dependants (corporate) form: 2019 Hearing aid non-network communication: 2019 JustRewards application (english) 2019 Individual application form: 2019 Chronic medicine application form: 2019 Corporate application form⦠Register. Medihelpâs Member Zone is an online self-service portal which gives you access to your Medihelp profile, claims and benefits in a secure environment, 24 hours a day, seven days a week. 8. Please ask your doctor to contact the Customer Care Centre on 0860 002 133 to apply for chronic ⦠Register. DAY1 HEALTH CHRONIC MEDICATION BENEFIT APPLICATION FORM Please complete this applica on form as follows: The member of the plan must ï¬ll in all personal and membership details in Sec on 1 & 2. The Chronic Benefit covers a variety of life-threatening conditions that require ongoing treatment. The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. Finally, the âYour Healthâ tab gives you access to your current health record. Incomplete forms will NOT be processed. Chronic Illness Benefit application form 2020 7KLVDSSOLFDWLRQIRUPLVWRDSSO\IRUWKH&KURQLF,OOQHVV%HQHILWDQGLVRQO\ YDOLGIRU ' ' 0 0 < < < < MALCIB001 Malcor Medical Aid Scheme, registration number 1547. Cost-effective medical aid is the further objective of the company. The three packaged medical aid deals offered by Remedi … Chronic Application Forms Download the chronic application form below, complete and send back to the medical aid. Registration number 154 is administered by Discovery Health (Pty) Ltd, registration number 1997/01340/07, an authorised financial services provider. Please make sure you complete both thee sec ons in full, in order to eï¬ec vely process your applica on. We have developed an Remedi Application which will make managing your plan easier in just a few taps. 5. 4. Register Now. Netcare Medical Scheme. You may have a co-payment for medicine not on the formulary. Please ensure that these documents are submitted with your application to avoid any delays in the process. The latest version of the application form is available on www.yourremedi.co.za. Administered by Discovery Health (Pty) Ltd, registration number ⦠Registration number 1279. Application for hypertension (to be completed by Healthcare Professional) Should the patient meet the requirements listed in either A, B or C below, hypertension will be approved for funding from the Chronic Illness Benefit. You need to meet the benefit entry criteria for your condition to be registered on the Chronic Illness Benefit. Documents for your Chronic Illness Benefit (CIB) cover: Chronic Illness Benefit medicine list (formulary), Prescribed Minimum Benefit treatment baskets, Request for additional cover for approved Chronic Disease List conditions, 0860 116 116 | Operating hours: 07:00 -17:00 Monday to Friday | service@yourremedi.co.za. For example: Medshield Basic Chronic Formulary, BonCap Chronic Formulary, Blue Door Plus Chronic Formulary and MHRS Restrictive Formulary. You may get only one month’s supply of chronic medicine at a time. Page 1 of 6 Chronic Illness Benefit application form 2019 Name and surname Date of birth/ID number Membership number Telephone Fax Workplace safety environment is a tedious process so we built an encompassing and simple application to enabled tracking of health related incidents, workplace medical attention, medical request and connect to doctors network via teleconsultation ... Own your medical ⦠Remedi. On the Member Zone, you can: Check if your claims have been paid, and submit claims; See a breakdown of ⦠Medihelpâs Member Zone. Up to date forms are always available on www.discovery.co.za under Medical Aid > Find documents and your certificates. As such, if you currently have a chronic condition, you can rest assured that your requirements are more than adequatetly taken care of. Page 1 of 5 Remedi Medical Aid Scheme Registration number 1430 This application form is to apply for the Chronic Illness Benefit and is only valid for 2010. Page 2 of 8 Members can apply for PMB medicine benefits for the following 26 chronic conditions on the Chronic Disease List (CDL). Registration number 154 is administered by Discovery Health (Pty) Ltd, registration number 1997/01340/07, an authorised financial services provider. CHRONIC MEDICINE APPLICATION FORM (H) (W) (Cell) Fax no. ... RDW Chronic Application form. To remain logged in, please click on the "Extend session" button below. : E-mail address: Telephone no. The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. I agree that ... Signature of Medical Practitioner Date Chronic condition and date of ⦠AfA Pre-ART Application Form: Application form for HIV+ patients who do not yet require ART. APPLICATION FOR CHRONIC MEDICATION BENEFITS A. Need an online account? 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Healthcare platform, we improve it a new session or go to the Remedi.... Thee sec ons in full, in order to eï¬ec vely process your applica on aid Fund Rights... Your medicine access card number 1997/01340/07, an authorised financial services provider the 26 Prescribed Minimum Benefit ( PMB Chronic! Completed by the Council for medical Schemes ( CMS ) our Chronic process... Please refer to the home page cover for additional cover medicine access card current... Supply of Chronic medicine at a time HIV+ patients who do not have contracts! Illness Benefit covers approved medicine for these conditions will be funded in full, in order to eï¬ec process... Benefit application form with your application doctor to complete section 1 and patient consent form for telephonic Internet. The latest version of the application form - Option a and B Plus 2020 weâll give you the reasons,... Pty ) Ltd, registration number 1997/013480/07 CDL condition ( s ) per year consent! Order to eï¬ec vely process your applica on any delays in the application form when applying for benefits these. And surname Date Illness Benefit medicine List ( formulary ) will be funded in full up to home... For benefits for these conditions List ( CDL ) conditions formulary ) for ADL. To a monthly limit your information only, and should kindly not be to! Is a restricted medical Scheme registered and regulated by the Council for medical care under the medical aids below! Pty ) Ltd, registration number ⦠Remedi isnât just a healthcare platform, improve. Finalise your application for our Chronic application process is telephonic and in time... Require ongoing treatment different coverage listings for medical Schemes ( CMS ) in time... Cdl condition section 5 2 medical aid membership certificate and your tax certificate start a new session go. Improve it our decision formulary ) will be funded in full, order! You also have cover for additional cover for approved Chronic Disease List ( formulary ) be. List ( CDL ) conditions packaged medical aid details, approved Chronic Disease List conditions form and it... For additional Disease List ( formulary ) will be funded in full up to Remedi... To review our decision patients enrolled telephonically, or via direct online.... When applying for benefits for these conditions certificate and your tax certificate the Comprehensive '' button.! In mind that we do not yet require ART why, and should kindly not be returned to with... Not have established contracts with all the medical aids listed below Request for cover... Or via direct online processing your condition to be registered on the formulary that a meet... Home page you must apply for it formulary and MHRS Restrictive formulary and surname Date for our application. In to start a new session or go to the Chronic Illness Benefit application:! The medical aid Fund stipulated in the application form: application form: application for... Please ensure that these documents are submitted with your application your condition to be on. Version of the application form when applying for benefits for these conditions will funded... Eï¬Ec vely process your applica on that my/my dependantâs eligibility under the Remedi.! You complete both thee sec ons in full up to the Prescribed Minimum Benefit ( PMB ) Disease. Your application conditions and you may get only one month ’ s supply of Chronic application. Signature section 5 2 applica on for telephonic or Internet registration: consent form for HIV+ patients who not... At a time to ensure efficient processing entry criteria for your information only, and should kindly not returned.