Application forms
Editable application forms are now available for you to complete digitally. You can navigate through the form by pressing the down arrow. If you can't physically sign a form, you must sign it digitally. We accept digital signatures from these digital signature providers:
- SigniFlow
- DocuSign
- Quickly Sign
- Hellosign
- Santamflow
- Smart Advice signatures
- Adobe Sign with certificate
Consent form to allow disclosure of information to a third party
Application for out-of-hospital management of a PMB condition
Application to become a member with underwriting
Advanced Illness Benefit application form
Application for registration of newborn baby
Application for additional services during an in-hospital admission for depression
Request for additional cover for out-of-hospital Prescribed Minimum Benefit conditions
Chronic Illness Benefit application form
HIVCare Programme application form
Member Application - no underwriting
Member Withdrawal application form
Permission to change banking details
Request for additional cover for PMB Chronic Disease List application form
Request for an extended supply of medicine
Request for Pre-exposure Prophylaxis
Transfer from active member to retiree status
Request for additional cover for Covid-19 testing
Request for additional cover for out of hospital Prescribed Minimum Benefit conditions
Benefit guides
Chronic Illness Benefit medicine list formulary
Chronic medicine list (formulary) provisional 2025
Cover for pregnancy and childbirth
Banking details for manual payments
Guide to Prescribed Minimum Benefit
Guide to In-Hospital Prescribed Minimum Benefit Treatment
Guide to transplant submission process
HIV Nutritional and mother to child prevention formulary
HIV Supportive medicine formulary
Prescribed Minimum Benefit (PMB) Treatment baskets
Prescribed Minimum Benefits Basket of Care for WHO Global Outbreak Benefit
Screening and Prevention Benefit
Treatment baskets for the Chronic Disease List (CDL) conditions