One Pagers
2025
2024
Application forms
For new members - joining the Scheme in 2025
Application to join LA Health Medical Scheme
For current members
Application for registration of a newborn
For current members - managing benefits
Advanced Illness Benefit application
Application for additional benefits
Application for additional out-of-hospital treatment over and above pmb
Application to add dependants (with underwriting)
Application to become a member (with underwriting)
Application for out-of-hospital management of a Prescribed Minimum Benefit condition
Application for registration of a new-born baby
Application for special payments made from the Medical Savings Account
Application to transfer an existing member to another employer or branch
Chronic Illness Benefit application form
Claim form for medical costs incurred outside SA
External Medical Items Extender Benefit Application (LA Comprehensive)
HIVCare programme application form
Membership/ dependant withdrawal form
New broker / brokerage appointment form
Permission to make certain information available to a third party
Request for extended supply of medicine
Request for pre-exposure prophylaxis (PREP)
Request to change banking details
Request to reverse the payment of a claim
Settlement agreement for an amount owing to LA Health Medical Scheme
Information Guides
Banking details for manual payments
Prescribed Minimum Benefits Chronic Medicine list
Chronic Illness Benefit medicine list Formulary
Chronic Disease List treatment baskets
Guide to Prescribed Minimum Benefits
Guide to prescribed minimum benefits for in-hospital treatment
Guide to transplant claims submissions
HIV Antiretroviral (ARV) medicine list
HIV Nutritional and mother-to-child medicine list (formulary)
HIV supportive medicine list (formulary)
LA KeyPlus Acute medicine list (formulary)
LA KeyPlus Dental medicine list (formulary)
Menopause medicine list (formulary)
Oncology Supportive Medicine List (formulary)
Prescribed minimum benefit WHO basket
Screening and Preventative Care Benefit
Supportive care after an admission