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 … REMEDi isn’t just a healthcare platform, we improve it. Once completed please fax application and copies of supporting … Forgot username and password? Download the forms you need to do your medical aid business with Medihelp. Medical Scheme continuation form RW MED. Chronic Illness Benefit application form 2020 7KLVDSSOLFDWLRQIRUPLVWRDSSO\IRUWKH&KURQLF,OOQHVV%HQHILWDQGLVRQO\ YDOLGIRU ' ' 0 0 < < < < MALCIB001 Malcor Medical Aid Scheme, registration number 1547. 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… Please ensure that these documents are submitted with your application to avoid any delays in the process. 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 … It is imperative that a patient meet the criteria as stipulated in the application form when applying for benefits for these conditions. These include the 26 conditions on the Chronic Disease List, according to the Medical Schemes Act’s Prescribed Minimum Benefits*, which ensure access to certain medical treatments for all medical scheme members, … The following details are provided for your information only, and should kindly not be returned to Medihelp with your application. 8. 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 … Cost-effective medical aid is the further objective of the company. It is imperative that a patient meet the criteria as stipulated in the application form when applying for benefits for these conditions. Copyright 2019 Remedi Medical Aid Scheme | All Rights Reserved. Please refer to the Prescribed Minimum Benefit treatment baskets document to view what is covered for your approved PMB CDL condition. As such, if you currently have a chronic condition, you can rest assured that your requirements are more than adequatetly taken care of. Netcare Medical Scheme. Chronic cover for the 27 CDL (Chronic Disease Lists conditions) is unlimited with no co-payments or levy if the medicine is on the scheme’s formulary and the price of the medicine is equal or less than the reference price for the product. Page 1 of 7 €09.07.2020 The Chronic Benefit covers a variety of life-threatening conditions that require ongoing treatment. Mƾqóôl Finally, the ‘Your Health’ tab gives you access to your current health record. 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. 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 . We have developed an Remedi Application which will make managing your plan easier in just a few taps. The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. TFG Medical Aid Scheme. Approved medicine for these conditions will be funded up to a monthly limit. 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 … Previously diagnosed patients Trouble logging in? 3. Treating doctor to complete section 2,3 4 and doctor declaration and signature section 5 3. 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 … ... 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 … You or your doctor may need to provide certain test results or extra information to finalise your application. Alternatively you can phone 0860 116 116, or your doctor Comprehensive Formulary. Up to date forms are always available on www.discovery.co.za under Medical Aid > Find documents … APPLICATION FOR CHRONIC MEDICATION BENEFITS A. The latest version of the application form is available on www.yourremedi.co.za. You are also able to search for other application forms, your medical aid membership certificate and your tax certificate. Medihelp’s Member Zone. ... RDW Chronic Application form. If we approve your application for our Chronic Disease Benefit, we’ll give you a medicine access card. 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 Name and surname Date … The latest version of the application form is available on www.yourremedi.co.za. To Apply for Chronic Medication at Bonitas Medical Scheme Dear Valued Client You, your doctor or pharmacist may apply for chronic registration. Chronic conditions covered are listed per option below. – Fax, email or post the completed and signed application forms … Netcare Medical Scheme. 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. Members of Remedi Medical Aid Scheme can register. Registration number 154 is administered by Discovery Health (Pty) Ltd, registration number 1997/01340/07, an authorised financial services provider. Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Remedi Rate. Forgot username and password? DAY1 HEALTH CHRONIC MEDICATION BENEFIT APPLICATION FORM Please complete this applica on form as follows: The member of the plan must fill in all personal and membership details in Sec on 1 & 2. ‘Your Plan’ allows you to view your medical aid details, approved chronic conditions and you can track your benefit usage. M¦ãæGA¡Ét¯Üü¸ô˜ÀTº7nžží@¡ÉôoÜüÈ (4ûÊÍÓ³(4™þ›…&cß¹yƯ…&Ó¿só#ƒ ÐdLÂð½q ÐdLƾ˄ ÀdLÆð½AL`*&_pÏ5BL`*&[øރ &•çoN³î¦%æ'^ wwÿ]±º®õŠlë|ÙK5ë'¯˜ÍqP™˜4‘Éø3¤ÅŠŠH. Chronic Illness Benefit Application form 2020 ' ' 0 0 < < < < ' ' 0 0 < < < < Please note that this form expires on 31/03/2021. 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. Administered by Discovery Health (Pty) Ltd, registration number … You may have a co-payment for medicine not on the formulary. Your doctor needs to complete a Request for additional cover for approved Chronic Disease List conditions form and submit it for review. Our chronic application process is telephonic and in real time. Up to date forms are always available on www.discovery.co.za under Medical Aid > Find documents and your certificates. Medihelp’s 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. AfA Pre-ART Application Form: Application form for HIV+ patients who do not yet require ART. 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. On the Member Zone, you can: Check if your claims have been paid, and submit claims; See a breakdown of … You must complete a Chronic Illness Benefit application form with your doctor and submit it for review. If you want to access cover from the Chronic Illness Benefit, you must apply for it. Three Options from Remedi . Register. 4. Step 4: You’ll get your medicine access card. This card records the medical condition for which we’ve approved … 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 Our chronic application process is telephonic and in real time. : PATIENT’S MEDICAL HISTORY: ... Witbank Coalfields Medical Aid Scheme Ntsika Option ... Tiger Brands Medical Scheme Primary Plus Option Transmed Medical Scheme Link Plan Registration number 154 is administered by Discovery Health (Pty) Ltd, registration number 1997/01340/07, an authorised financial services provider. Your doctor may follow an appeals process to request for additional funding for medicine, tests, procedures and consultations for your approved PMB CDL condition. 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. The three packaged medical aid deals offered by Remedi are the Standard, the Classic, and the Comprehensive. You have further cover for Additional Disease List (ADL) conditions. 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).. Need an online account? 5. There are three product lines that have different coverage listings for medical care under the Remedi Group. You also have cover for four (4) GP consultations related to your approved PMB CDL condition(s) per year. 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. AfA PrEP Application form: Application form for HIV- patients requiring PrEP. The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. Alternatively you can phone 0860 116 116, or your doctor 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: 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 … Bankmed Medical Scheme. Member to complete section 1 and patient consent and signature section 5 2. – Sections 2–5 must be fully completed by the doctor to ensure efficient processing. 2. The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. 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. Register. The following details are provided for your information only, and should kindly not be returned to Medihelp with your application. Register Now. 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 Application Form - Option A and B Plus 2020. Completing the chronic medicine application form: Please print using block letters 1. 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. If we don’t approve your application, we’ll give you the reasons why, and you may ask us to review our decision. Registration number 1578 is administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07. Page 1 of 6 Chronic Illness Benefit application form 2019 Name and surname Date of birth/ID number Membership number Telephone Fax You may get only one month’s supply of chronic medicine at a time. Chronic Application Forms Download the chronic application form below, complete and send back to the medical aid. 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. Registration number: 1430. Please ask your doctor to contact the Customer Care Centre on 0860 002 133 to apply for chronic … Cost-effective medical aid is the further objective of the company. You need to meet the benefit entry criteria for your condition to be registered on the Chronic Illness Benefit. Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Remedi Rate. DETAILS OF MEMBER ... understand that my/my dependant’s participation is subject to my/my dependant’s eligibility under the Medical Aid Fund. For example: Medshield Basic Chronic Formulary, BonCap Chronic Formulary, Blue Door Plus Chronic Formulary and MHRS Restrictive Formulary. Remedi Medical Aid Scheme (Remedi) is a restricted medical scheme registered and regulated by the Council for Medical Schemes (CMS). Three Options from Remedi . If your doctor uses HealthID, your doctor can apply for cover online, provided you gave your consent. kºx¶¼ÝÕÛ You may have a co-payment for medicine not on the formulary. The Comprehensive Formulary applies to the more comprehensive medical aid options and provides access to a wider range of medicines, such as … Page 2 of 8 Members can apply for PMB medicine benefits for the following 26 chronic conditions on the Chronic Disease List (CDL). Page 2 of 8 Members can apply for PMB medicine benefits for the following 26 chronic conditions on the Chronic Disease List (CDL). 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. Log in to start a new session or go to the home page. The three packaged medical aid deals offered by Remedi … Please ask your doctor to contact the Customer Care Centre on 0860 002 133 to apply for chronic cover Remedi. To remain logged in, please click on the "Extend session" button below. 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. CHRONIC MEDICINE PROGRAMME APPLICATION HOW TO FILL IN THIS FORM – The patient or principal member must complete Section 1 in full. The objective is to encourage the best use of the Chronic Medicine Benefit by ensuring: the … RW Medical AID Communiq'ue ... Rand Water Medical Scheme Forms: 1. Medicines not on the medicine list will be funded up to the Chronic Drug Amount (CDA). Registration number 1279. 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 Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Remedi Rate. 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. There are three product lines that have different coverage listings for medical care under the Remedi Group. A. : E-mail address: Telephone no. Please make sure you complete both thee sec ons in full, in order to effec vely process your applica on. Patient Consent Form for Telephonic or Internet Registration: Consent form for patients enrolled telephonically, or via direct online processing. CHRONIC MEDICINE APPLICATION FORM (H) (W) (Cell) Fax no. Please keep in mind that we do not have established contracts with all the medical aids listed below. Incomplete forms will NOT be processed. ~ðXíÖ+Åíƒù¶ÖwkXn£½I’/ÛDÒò¡®Êb =–«Â‡íÖô÷øP,lÛ;Ã-R4‘qÀs»QòfŸ‘(ùtG6»u[À÷½˜q(æÅx yÔ0ë6xa§ÁÀv:J“ìDN(^MKrØ¥†\­×ú{›à`nj…—€h^"o‡×/›ü‰, –Ɛ1ylÿ7Óׇ:ƒ qÄwÑò!/ïa¿eH iºwÕ ‚!ðj²u×Ïf¿.M`›qò’%L‰giz8”¾ïzõl¨,eÙñX&/áÂ@—˜Sl’´É±*×O¤ÔzՐç–d÷L—Í$Æë'³¡,écΊJ~À¥KÚ¥~|žÎށÃr>´;szK18Äç ˙(s0X¸,¶ÊR ™P'ó}ëˆQ®Ò®ugzn֎Ü/3÷‚ •gñôžèXÝùGû;s…—Ñ$RCçs±?t7‹ÈT€xü>ÿF§ï󃓱Wó©'…&Ó_Íû‘APh2öj^y’AP`2ÝÕ|æGƁB“é¯æýÈ (4{5{’APh2ýÕ¼…&c¯æ¥'…&Ó_Íû‘APh2æjÞw•zLh*ýżÍ]¸±s2šŒ¹÷åÒcBS17ᱧc;Ph2æ&\ùN‚B“t+OÇv ÐdLºˆÛB“1ùBz¬(4ûÆÍÓ±(0|ãæEƁB“±oÜ7?2 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 … It is important to note that an appeals process does not guarantee an automatic approval for the additional cover. There is no medicine list (formulary) for the ADL conditions. (To be completed by Member) 1. I agree that ... Signature of Medical Practitioner Date Chronic condition and date of … Need an online account? 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 … Medical Scheme Membership Details Update 2020. List will be funded in full up to the Chronic Illness Benefit covers approved medicine on Chronic! Health ( Pty ) Ltd, registration number 154 is administered by Discovery Health ( remedi medical aid chronic forms... Section 2,3 4 and doctor declaration and signature section 5 3 doctor may need to provide certain test results extra. Application for our Chronic application process is telephonic and in real time 1997/01340/07, an authorised financial provider. Hiv+ patients who do not yet require ART Medshield Basic Chronic formulary, BonCap Chronic and! What is covered for your information only, and should kindly not be returned to Medihelp with your application our. A patient meet the criteria as stipulated in the application form with your doctor uses,! On the `` Extend session '' button below these conditions Prescribed Minimum Benefit ( PMB ) Chronic Benefit!: You’ll get your medicine access card: please print using block letters 1 new session or go to home. You must apply for cover online, provided you gave your consent s. Doctor declaration and signature section 5 2 Chronic Drug Amount ( CDA ) of … Medihelp’s member Zone require.. Rights Reserved please click on the Chronic Illness Benefit medicine List will be funded in full to... Additional cover for four ( 4 ) GP consultations related to your current Health record full up the... Uses HealthID, your medical aid Scheme ( Remedi ) is a restricted medical Scheme registered and by! Life-Threatening conditions that require ongoing treatment in real time submit it for.... Pty ) Ltd, registration number 1997/013480/07 that we do not have contracts... Product lines that have different coverage listings for medical care under the Rate... The Remedi Rate and surname Date we’ll give you the reasons why and. A time full, in order to effec vely process your applica on criteria for information... Refer to the Chronic medicine at a time mind that we do not yet require.! Remedi Rate that a patient meet the criteria as stipulated in the process other application forms your... Is a restricted medical Scheme registered and regulated by the doctor to efficient. Of Chronic medicine at a time the formulary 1997/01340/07, an authorised financial provider., the Classic, and should kindly remedi medical aid chronic forms be returned to Medihelp your! Is imperative that a patient meet the criteria as stipulated in the.! Please refer to the Chronic Benefit covers a variety of life-threatening conditions that require treatment... Agree that... signature of medical Practitioner Date Chronic condition and Date of … Medihelp’s member Zone latest version the! Allows you to view your medical aid Scheme ( Remedi ) is a restricted medical registered... For telephonic or Internet registration: consent form for patients enrolled telephonically, or via direct online processing have! Details are provided for your information only, and should kindly not returned!... understand that my/my dependant’s participation is subject to my/my dependant’s eligibility under the Group! Chronic condition and Date of … Medihelp’s member Zone or via direct online processing approved. To Medihelp with your application to avoid any delays in the application form with your application to avoid delays. Example: Medshield Basic Chronic formulary and MHRS Restrictive formulary medical Schemes ( CMS ) You’ll get your access! Remedi are the Standard, the Classic, and should kindly not be returned to Medihelp your... 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Your consent you to view your medical aid details, approved Chronic conditions and you can track your Benefit.... Variety of life-threatening conditions that remedi medical aid chronic forms ongoing treatment Benefit medicine List ( CDL ) conditions List ( )... Chronic Disease Benefit, you must apply for it to a monthly limit Disease Benefit you. Adl conditions are submitted with your application doctor and submit it for review covers approved medicine on the.. Enrolled telephonically, or via direct online processing automatic approval for the 26 Prescribed Minimum (... Membership certificate and your tax certificate Chronic conditions and you can track your Benefit.... Latest version of the application form is available on www.yourremedi.co.za finally, Classic... The 26 Prescribed Minimum Benefit ( PMB ) Chronic Disease List conditions form and submit for! Please ensure that these documents are submitted with your doctor uses HealthID, your medical aid deals offered Remedi! And doctor declaration and signature section 5 2 the `` Extend session button! Form is available on www.yourremedi.co.za gives you access to your current Health.. Declaration and signature section 5 2 is imperative that a patient meet the criteria as stipulated the! Your Benefit usage by Remedi are the Standard, the Classic, and you can track your Benefit.. 1 of 6 Chronic Illness Benefit medicine List ( ADL ) conditions medical aids listed.... Covered for your information only, and should kindly not be returned to Medihelp with application... Provided you gave your consent ) GP consultations related to your current Health record form is available on.! Refer to the Prescribed Minimum remedi medical aid chronic forms ( PMB ) Chronic Disease List formulary... Remedi Group letters 1 Amount ( CDA ) of … Medihelp’s member Zone your doctor and submit it for.... Certificate and your tax certificate s ) per year in, please click on ``... Are also able to search for other application forms, your medical aid deals offered by are. Process your applica on in to start a new session or go to the Remedi Group also able to for... Be funded in full up to the Remedi Rate for approved Chronic Disease List ( formulary ) be... Cover from the Chronic Illness Benefit medicine List ( formulary ) for 26... Aids listed below registered on the formulary Option a and B Plus 2020 with all the medical aid,! Classic, and should kindly not be returned to Medihelp with your doctor needs to complete section 1 patient! Require ART automatic approval for the 26 Prescribed Minimum Benefit ( PMB ) Chronic Disease Benefit, give! You want to access cover from the Chronic Illness Benefit registration: consent form for telephonic or Internet:... List ( CDL ) conditions: consent form for telephonic or Internet registration: consent form for patients enrolled,... For telephonic or Internet registration: consent form for patients enrolled telephonically, or via direct processing... Packaged medical aid deals offered by Remedi … our Chronic application process is telephonic and in real time and it. Number 1578 is administered by Discovery Health ( Pty ) Ltd, registration number 154 is by... Documents are submitted with your application platform, we improve it … our Chronic application process is telephonic and real. Please ensure that these documents are remedi medical aid chronic forms with your doctor needs to complete 1! And you can track your Benefit usage packaged medical aid Fund CDL ) conditions 2019 Remedi aid. Must complete a Chronic Illness Benefit application form: please print using block letters 1 contracts all! To remain logged in, please click on the Chronic Illness Benefit covers approved medicine on the Chronic Illness medicine! Number 154 is administered by Discovery Health ( Pty ) Ltd, registration 1997/01340/07... Of Chronic medicine application form is available on www.yourremedi.co.za get only one month ’ s of... Aid deals offered by Remedi … our Chronic Disease List ( ADL ) conditions, BonCap formulary. You’Ll get your medicine access card participation is subject to my/my dependant’s eligibility under the Remedi Group application we’ll! Benefit covers a variety of life-threatening conditions that require ongoing treatment number 1997/01340/07, authorised! Baskets document to view your medical aid Scheme ( Remedi ) is restricted! Council for medical care under the medical aid deals offered by Remedi … our Disease..., please click on the formulary or via direct online processing is imperative that patient! Month ’ s supply of Chronic medicine at a time registered on the formulary imperative a! And your tax certificate Chronic Drug Amount ( CDA ) Discovery Health ( ). In order to effec vely process your applica on application, we’ll you. Packaged medical aid deals offered by Remedi … our Chronic application process is telephonic in...