Bankmed Medical Aid Scheme

forms

To select the relevant form, click on the applicable link below.

For your convenience, the 2013 Application for Membership form can be completed by typing the required information within the highlighted areas. Once completed, you (and any beneficiaries aged 12 years or older) will need to print and sign the form wherever personal signatures are required.

2013 Application for Membership

Application to register a newborn baby as a dependant

2013 Out-of-Network Reimbursement Form for Basic Plan

2012 Out-of-Network Reimbursement Form for Basic Plan

Chronic Appliance Benefit Application

Chronic Medicine Indemnity Form/Undertaking (for additional supplies of chronic medication when a beneficiary is travelling overseas)

Bankmed Network GP nomination form (Core Saver Plan only)

Medicine Advisory Services Application (for chronic medication)

Personal Health Assessment & HIV/AIDS Counselling and Testing Questionnaire

Resignation Form

Special Care: Baby-and-me Application

Special Care: Programme Application