Forms
- 2023 Option Change Form
- Application for membership form
- Debit Order Form - Active Members
- Debit Order Form - Sanlam/Pensioners
- Personal Medical Saving Account Payment Authorisation
- Termination of membership form
- Consent Form
- Declaration of income/Pension
- Change in membership details form
- Change in personal details form
- Affidavit for the registration of a partner
- General information and affidavit for siblings, parents and children over 21 of principal member
- Chronic medication application form (Medicine Risk Management)
- Psychiatry Management Programme application form
- Spinal Programme Information form (Back)
- Spinal Programme Information form (Neck)
- Maternity Programme application form
- Integrated Care Programme (Disease Risk Management)
- HIV Disease Management Programme Form - Aids for AIDS
- HIV Disease Management Programme Post-Exposure Prophylaxis Form
- Application for nursing care benefits
- Palliative Care application form
Contact Us
Client Services
Tel: 0860 100 078
Fax: 086 566 1372
Managed Care Services (including hospital pre-authorisation & ICON)
0860 100 078
MEDiPOS Anti-fraud Hotline
Tel: 0800 112 811
Email
enquiries@medipos.co.za
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