Scheme Forms for Members 2022 - Medshield

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Below are a list of Scheme forms required to make changes or additions to your membership. We include both a manual format and an easily electronic editable format. Please download the editable format to insert the signatures after which the completed form can be emailed to the relevant email address as detailed on the form. The editable electronic format is indicated as “Auto”.

Active Swopping (Change of Principal Member)
Auto
Manual
Advance Chronic Medication request
Manual
Change of Banking Details
Auto
Manual
Contribution Refund request
Auto
Manual
Dependant Termination request
Auto
Manual
Existing Beneficiary Transfer (to another membership)
Auto
Manual
Ex-Gratia Benefits application
Manual
Family Practitioner (FP) Nomination
Auto
Manual
Member Application
Auto
Manual
Member Health Declaration
Auto
Manual
Member Record Amendment – Dependant Registration
Auto
Manual
New Born Registration form
Auto
Manual
New Membership – Beneficiary Continuation
Auto
Manual
Oncology Treatment Application
Manual
Option Change request
Auto
Manual
Orthotic & Prosthetic Application
Manual
PMB Application
Auto
Manual
PMSA Refund
Auto
Savings Refund request
Auto
Manual
Termination request
Auto
Manual
Third Party Consent
Auto
Manual