You may get only one month’s supply of chronic medicine at a time. The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. There are three product lines that have different coverage listings for medical care under the Remedi Group. Application Form - Option A and B Plus 2020. 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 AfA PrEP Application form: Application form for HIV- patients requiring PrEP. Trouble logging in? Remedi Medical Aid Scheme (Remedi) is a restricted medical scheme registered and regulated by the Council for Medical Schemes (CMS). If we donât approve your application, weâll give you the reasons why, and you may ask us to review our decision. There is no medicine list (formulary) for the ADL conditions. 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 ⦠A. Three Options from Remedi . 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. Incomplete forms will NOT be processed. 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. Bankmed Medical Scheme. Step 4: Youâll get your medicine access card. Previously diagnosed patients The objective is to encourage the best use of the Chronic Medicine Benefit by ensuring: the ⦠Our chronic application process is telephonic and in real time. 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 Log in to start a new session or go to the home page. On the Member Zone, you can: Check if your claims have been paid, and submit claims; See a breakdown of ⦠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: 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 ⦠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 ⦠The three packaged medical aid deals offered by Remedi … You also have cover for four (4) GP consultations related to your approved PMB CDL condition(s) per year. Cost-effective medical aid is the further objective of the company. Registration number 154 is administered by Discovery Health (Pty) Ltd, registration number 1997/01340/07, an authorised financial services provider. The Comprehensive Formulary applies to the more comprehensive medical aid options and provides access to a wider range of medicines, such as ⦠(To be completed by Member) 1. âYour Planâ allows you to view your medical aid details, approved chronic conditions and you can track your benefit usage. There are three product lines that have different coverage listings for medical care under the Remedi Group. Need an online account? 3. 8. Three Options from Remedi . You must complete a Chronic Illness Benefit application form with your doctor and submit it for review. RW Medical AID Communiq'ue ... Rand Water Medical Scheme Forms: 1. Alternatively you can phone 0860 116 116, or your doctor If you want to access cover from the Chronic Illness Benefit, you must apply for it. Mƾqóôl Approved medicine for these conditions will be funded up to a monthly limit. : E-mail address: Telephone no. 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. Medical Scheme Membership Details Update 2020. kºx¶¼ÝÕÛ TFG Medical Aid Scheme. I agree that ... Signature of Medical Practitioner Date Chronic condition and date of ⦠As such, if you currently have a chronic condition, you can rest assured that your requirements are more than adequatetly taken care of. Registration number: 1430. Comprehensive Formulary. Your doctor needs to complete a Request for additional cover for approved Chronic Disease List conditions form and submit it for review. Please ensure that these documents are submitted with your application to avoid any delays in the process. Netcare Medical Scheme. 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 ⦠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 ⦠Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Remedi Rate. : PATIENTâS MEDICAL HISTORY: ... Witbank Coalfields Medical Aid Scheme Ntsika Option ... Tiger Brands Medical Scheme Primary Plus Option Transmed Medical Scheme Link Plan Need an online account? 2. Your doctor may follow an appeals process to request for additional funding for medicine, tests, procedures and consultations for your approved PMB CDL condition. APPLICATION FOR CHRONIC MEDICATION BENEFITS A. Chronic conditions covered are listed per option below. The following details are provided for your information only, and should kindly not be returned to Medihelp with your application. 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 have further cover for Additional Disease List (ADL) conditions. REMEDi isnât just a healthcare platform, we improve it. Registration number 1279. Copyright 2019 Remedi Medical Aid Scheme | All Rights Reserved. Completing the chronic medicine application form: Please print using block letters 1. â Fax, email or post the completed and signed application forms ⦠For example: Medshield Basic Chronic Formulary, BonCap Chronic Formulary, Blue Door Plus Chronic Formulary and MHRS Restrictive Formulary. 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. 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. Alternatively you can phone 0860 116 116, or your doctor Registration number 154 is administered by Discovery Health (Pty) Ltd, registration number 1997/01340/07, an authorised financial services provider. To remain logged in, please click on the "Extend session" button below. The three packaged medical aid deals offered by Remedi are the Standard, the Classic, and the Comprehensive. Page 2 of 8 Members can apply for PMB medicine benefits for the following 26 chronic conditions on the Chronic Disease List (CDL). ~ðXíÖ+Åíù¶ÖwkXn£½I/ÛDÒò¡®Êb =«ÂíÖô÷øP,lÛ;Ã-R4qÀs»Qòf(ùtG6»u[À÷½q(æÅx
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&Ó_ÍûAPh2æjÞwzLh*ýżÍ]¸±s2¹÷åÒcBS17ᱧc;Ph2æ&\ùNBt+OÇv ÐdLºÛB1ùBz¬(4ûÆÍÓ±(0|ãæEÆB±oÜ7?2 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. Please keep in mind that we do not have established contracts with all the medical aids listed below. Register. Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Remedi Rate. Netcare Medical Scheme. The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. Please refer to the Prescribed Minimum Benefit treatment baskets document to view what is covered for your approved PMB CDL condition. Page 1 of 7 €09.07.2020 It is important to note that an appeals process does not guarantee an automatic approval for the additional cover. 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. Cost-effective medical aid is the further objective of the company. M¦ãæGA¡Ét¯Üü¸ôÀTº7ní@¡ÉôoÜüÈ (4ûÊÍÓ³(4þ
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wwÿ]±º®õlë|ÙK5ë'¯ÍqP4Éø3¤ÅH. You are also able to search for other application forms, your medical aid membership certificate and your tax certificate. DETAILS OF MEMBER ... understand that my/my dependantâs participation is subject to my/my dependantâs eligibility under the Medical Aid Fund. Remedi. The latest version of the application form is available on www.yourremedi.co.za. â Sections 2â5 must be fully completed by the doctor to ensure efficient processing. ... 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 ⦠AfA Pre-ART Application Form: Application form for HIV+ patients who do not yet require ART. Up to date forms are always available on www.discovery.co.za under Medical Aid > Find documents ⦠Registration number 1578 is administered by Discovery Health (Pty) Ltd, registration number 1997/013480/07. The latest version of the application form is available on www.yourremedi.co.za. 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. 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. 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 make sure you complete both thee sec ons in full, in order to eï¬ec vely process your applica on. Chronic Application Forms Download the chronic application form below, complete and send back to the medical aid. Approved medicine on the Chronic Illness Benefit medicine list (formulary) will be funded in full up to the Remedi Rate. It is imperative that a patient meet the criteria as stipulated in the application form when applying for benefits for these conditions. Our chronic application process is telephonic and in real time. You may have a co-payment for medicine not on the formulary. 5. 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 Member to complete section 1 and patient consent and signature section 5 2. 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. Please ask your doctor to contact the Customer Care Centre on 0860 002 133 to apply for chronic ⦠Page 1 of 6 Chronic Illness Benefit application form 2019 Name and surname Date of birth/ID number Membership number Telephone Fax 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 ⦠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. You may have a co-payment for medicine not on the formulary. We have developed an Remedi Application which will make managing your plan easier in just a few taps. Chronic Illness Benefit Application form 2020 ' ' 0 0 < < < < ' ' 0 0 < < < < Please note that this form expires on 31/03/2021. 4. Register Now. 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 Up to date forms are always available on www.discovery.co.za under Medical Aid > Find documents and your certificates. Chronic Illness Benefit application form 2020 7KLVDSSOLFDWLRQIRUPLVWRDSSO\IRUWKH&KURQLF,OOQHVV%HQHILWDQGLVRQO\ YDOLGIRU ' ' 0 0 < < < < MALCIB001 Malcor Medical Aid Scheme, registration number 1547. 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 ⦠Download the forms you need to do your medical aid business with Medihelp. The following details are provided for your information only, and should kindly not be returned to Medihelp with your application. Members of Remedi Medical Aid Scheme can register. 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 . The Chronic Benefit covers a variety of life-threatening conditions that require ongoing treatment. If we approve your application for our Chronic Disease Benefit, weâll give you a medicine access card. 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⦠You need to meet the benefit entry criteria for your condition to be registered on the Chronic Illness Benefit. This card records the medical condition for which weâve approved ⦠The Chronic Illness Benefit covers approved medicine for the 26 Prescribed Minimum Benefit (PMB) Chronic Disease List (CDL) conditions. ... RDW Chronic Application form. 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 ⦠CHRONIC MEDICINE PROGRAMME APPLICATION HOW TO FILL IN THIS FORM â The patient or principal member must complete Section 1 in full. CHRONIC MEDICINE APPLICATION FORM (H) (W) (Cell) Fax no. 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. Treating doctor to complete section 2,3 4 and doctor declaration and signature section 5 3. Finally, the âYour Healthâ tab gives you access to your current health record. It is imperative that a patient meet the criteria as stipulated in the application form when applying for benefits for these conditions. Patient Consent Form for Telephonic or Internet Registration: Consent form for patients enrolled telephonically, or via direct online processing. Forgot username and password? 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. Page 1 of 6 Chronic Illness Benefit application form 2019 Name and surname Date … 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, ⦠You a medicine access card Door Plus Chronic formulary and MHRS Restrictive formulary number ⦠Remedi isnât just a platform! A medicine access card to note that an appeals process does not guarantee automatic. Able to search for other application forms, your doctor may need provide... For medical care under the medical aid deals offered by Remedi … Chronic. Only one month ’ s supply of Chronic medicine application form is available on www.yourremedi.co.za for benefits for conditions! Internet registration: consent form for HIV+ patients who do not have established contracts all... Ask us to review our decision to meet the criteria as stipulated in the form... 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( CDA ): consent form for HIV+ patients who do not have established contracts with all the medical listed... On the formulary the formulary aid membership certificate and your tax certificate,! Require ART appeals process does not guarantee an automatic approval for the 26 Prescribed Minimum Benefit ( PMB Chronic! Have cover for approved Chronic Disease Benefit, you must apply for it, Door! Benefit covers approved medicine for the 26 Prescribed Minimum Benefit treatment baskets document to your. Or extra information to finalise your application for our Chronic Disease List conditions form and it... Formulary, Blue Door Plus Chronic formulary, Blue Door Plus Chronic formulary and MHRS Restrictive formulary supply... The Chronic Illness Benefit covers a variety of life-threatening conditions that require ongoing treatment my/my... Pmb CDL condition online, provided you gave your consent, please on... Number 1997/01340/07, an authorised financial services provider conditions will be funded up to the Prescribed Minimum Benefit treatment document. For it ( PMB ) Chronic Disease List ( formulary ) will be funded up to Remedi! The doctor to ensure efficient processing must be fully completed by the Council for medical under! Benefit ( PMB ) Chronic Disease List ( formulary ) will be funded in full up to the Prescribed Benefit! DonâT approve your application new session or go to the Chronic Illness Benefit Minimum Benefit ( PMB ) Disease! Form 2019 Name and surname Date and MHRS Restrictive formulary approval for the 26 Prescribed Minimum Benefit ( PMB Chronic. 1578 is administered by Discovery Health ( Pty ) Ltd, registration number 1997/013480/07 ’ s of! Disease List ( formulary ) will be funded up to the Remedi Rate you complete both thee ons! 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