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Benefit and Contribution Schedules

 2021 Benefit and Contribution Schedule View PDF  

Application Forms

 Application to become a member of Bankmed (with MQ) View PDF  
 Application to add dependants View PDF  
 Application to register a newborn baby View PDF  
 Baby-and-Me View PDF  
 Continuation form View PDF  
 Declaration of medical scheme membership View PDF  
 Declaration of medical scheme membership View PDF  
 Health declaration View PDF  
 Advanced Illness Benefit & Compassionate Care Benefit application form View PDF  
 Application for bariatric surgery View PDF  
 Application for negative pressure wound therapy View PDF  
 Application for out-of-hospital management of a Prescribed Minimum Benefit condition View PDF  
 Application for wound care View PDF  
 Chronic Illness Benefit (Core Saver, Traditional, Comprehensive and Plus Plans) View PDF  
 Chronic Illness Benefit (Essential and Basic Plans) View PDF  
 Chronic Medication Indemnity and Advance Supply Form (Core Saver, Traditional, Comprehensive and Plus Plans) View PDF  
 GP to specialist referral form View PDF  
 HIV PMB application form View PDF  
 HIV Programme View PDF  
 Hospital admission complaint form View PDF  
 International travel benefit claims View PDF  
 Lymphoedema Assessment Form View PDF  
 Medication Advisory Services (Chronic Medication Programme) Enrolment Form View PDF  
 Pathology request View PDF  
 Personal Health Assessment (PHA) & HIV/AIDS Counselling & Testing (HCT) View PDF  
 Prescribed Minimum Benefits Appeal View PDF  
 Radiology request View PDF  
 Request for additional cover for PMB CDL conditions registered on the Chronic Illness Benefit (Core Saver, Traditional, Comprehensive and Plus Plans) View PDF  
 Request for additional cover for PMB CDL conditions registered on the Chronic Illness Benefit (Essential and Basic Plans) View PDF  
 Request for extended supply of medication View PDF  
 Request for pre-exposure prophylaxis (PREP) View PDF  
 Application for special payments made from the Medical Savings Account View PDF  
 Application to become an Employer Contact View PDF  
 Bankmed Add Minor View PDF  
 Bankmed Confirm Adoption View PDF  
 Change of Employer View PDF  
 Ex Gratia View PDF  
 Member and/or dependant resignation form (To be completed by member) View PDF  
 Plan selection form View PDF  
 Pre-assessment request View PDF  
 Request to change banking details View PDF  
 Reverse payment of a valid claim View PDF  
 Reverse payment of a valid claim (non SARB members) View PDF  
 Settlement agreement View PDF  
 Transfer from Active to Retiree Status View PDF  

Benefit Guides

 Cover for pregnancy and childbirth View PDF  
 Acute medicine list (Basic Plan) View PDF  
 Advanced Illness Benefit View PDF  
 Banking details for Employers View PDF  
 Compassionate Care View PDF  
 Dental formulary (Basic Plan) View PDF  
 Diabetes Care Programme View PDF  
 Emergency services View PDF  
 Mental Health Care Programme View PDF  
 Motor Vehicle Accident View PDF  
 Optical benefit (Core Saver and Plus Plans) View PDF  
 Optical benefit (Essential and Basic Plans) View PDF  
 Wellness and Preventative Care Benefits View PDF  
 HIV Programme View PDF  
 HIV Supportive medicine list (formulary) View PDF  
 HIV Basket of care medicine list (formulary) View PDF  
 HIV Antiretroviral medicine list (formulary) View PDF  
 HIV Nutritional and mother-to-child medicine list (formulary) View PDF  
 Chronic Illness Benefit CDL formulary View PDF  
 Medicine Advisory Services View PDF  
 Prescribed Minimum Benefit treatment baskets View PDF  
 Prescribed Minimum Benefits basket of care for COVID-19 View PDF  
 Guide to Prescribed Minimum Benefits for In-hospital treatment View PDF  
 Guide to Prescribed Minimum Benefits View PDF  
 Guide to Transplant Claims View PDF  
 Managed Care Oncology Prorgamme View PDF  
 Oncology supportive medicine list (formulary) View PDF  
 Letter about International Claims View PDF  

Medications

 Chronic Illness Benefit CDL formulary View PDF  
 HIV Supportive medicine list (formulary) View PDF  
 Acute medicine list (Basic Plan) View PDF  
 Dental formulary (Basic Plan) View PDF  
 HIV Antiretroviral medicine list (formulary) View PDF  
 HIV Antiretroviral medication formulary View PDF  
 HIV Nutritional and mother-to-child medicine list (formulary) View PDF