Forms
Click on an application form's name to download or display a printable PDF of the form.
Application forms
For new members – joining the scheme
Application to join LA Health Medical Scheme
Application to join LA Health Medical Scheme – with underwriting
For current members – adding or changing members
Application for registration of a newborn baby
Continuation form (changing the main member)
For current members – managing benefits
Additional Health Benefits application form
Advanced Illness Benefit application form
Application for out-of-hospital management of a Prescribed Minimum Benefit condition
Application for additional out-of-hospital treatment over and above PMB
Chronic Illness Benefit Application form
Chronic Illness Benefit – Request for extended supply of medicine
HIVCare Programme application form
HIV Prescribed Minimum Benefit appeal form
KeyPlus application for chronic dialysis
Prescribed Minimum Benefits (PMB) Chronic Disease List (CDL) appeal form
Request for pre-exposure prophylaxis
For current members – managing membership
External Medical Items Extender Benefit application Form
International Travel Benefit Form
Permission to change banking details
Permission to make certain information available to a third party
Special payments from Medical Savings Account
Transfer from active to retiree status
Benefit guides
Banking details for manual payments
Chronic Illness Benefit CDL medicine list
Guide to transplant claims submissions
Guide to Prescribed Minimum Benefits
HIV antiretroviral (ARV) medicine list
HIV Nutritional and mother-to-child medicine list (formulary)
LA KeyPlus Acute medicine list (formulary)
LA KeyPlus Dental medicine list (formulary)