Forms
Click on an application form's name to download or display a printable PDF of the form.
For new members – joining the scheme
- Application to join LA Health Medical Scheme 2012
- Application to join LA Health Medical Scheme 2011
- Application to join Vitality and KeyClub
For current members – adding or changing members
- Additional dependant application form
- Application for registration of newborn baby
- Continuation form (changing the main member)
For current members – managing benefits
- Application for out-of-hospital management of a Prescribed Minimum Benefit condition
- Chronic Illness Benefit – Request for extended supply of medicine
- Chronic Illness Benefit Application form
- HIV Prescribed Minimum Benefit appeal form
- International Claim Form
- Oncology Motivation Form
- Prescribed Minimum Benefits (PMB) Chronic Disease List (CDL) appeal form
For current members – managing membership
- Application for cover for oxygen therapy
- Broker appointment form
- Ex gratia application form
- HIVCare Programme application form
- Member Withdrawal Form
- Option Change Form
- Overseas claim form
- Partnership declaration
- Permission to change banking details for claims payment
- Permission to change banking details for debit order details
- Permission to make certain information available to a third party
- Settlement form (Afrikaans)
- Special payments from Medical Savings Account
- Transfer from active to retiree status