Forms

Claim forms

Member PMB Request

Note
The form below needs to be completed by your service provider and e-mailed to managedcare@dbbs.co.za.

 

Member forms

New Member Registration

Note
Include proof of membership of all previous medical aid schemes.
Please take note that all documents as stated on the form must be submitted.

 

New Dependant Registration

Note
Include proof of membership of all previous medical aid schemes.
Please take note that all documents as stated on the form must be submitted.
Waiting periods may be imposed.

 

Registration Dependant Child

Note
Dependency must be proven each year for dependants over the age of 21.
Re-registration – please take note of Ruling 9 with regard to eligibility.

 

Registration Dependant Adult

Note
Include proof of membership of all previous medical aid schemes.
Please take note that all documents as stated on the form must be submitted.
Waiting periods and late joiner penalties may be imposed.

 

Registration of Marriage

Note
To register a spouse/partner as a dependant kindly complete the forms listed under New Dependant Registration as well.

 

Resignation of Member

Note
Where a member will be joining another Medical Scheme, proof of membership to the new scheme must accompany the form submitted.
A member may terminate his membership, but must give one month’s prior written notice to the Society.

 

Resignation of Dependant

Note
A member may terminate the membership of one or more of his dependants, but must give one month’s prior written notice to the Society.

 

Resignation of Employment

 

Retirement and Retrenchment

 

Death in Service

 

Transfers and Seconded Employees

 

Member Contact Details Update

 

Practice/Provider forms

Provider Banking details

Note
Please note that the original credit order instruction form, duly authorised and completed by the provider, must be submitted to the Society, accompanied by either an original cancelled cheque or an original letter from the bank or an original bank stamp on this form for verification purposes. No faxed, e-mailed or other electronic documents will be accepted.

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HIV registration forms

Note
The forms listed below need to be completed and signed by the relevant dependant as well as the treating doctor and e-mailed to HIV@dbbs.co.za and afa@afadm.co.za accompanied by the pathology reports and prescription where applicable.

AfA Application

Note
The form listed below must be completed for all beneficiaries requiring registration for HIV and ART treatment.

 

AfA PEP Application

Note
The form listed below must be completed for all beneficiaries requiring registration for post-exposure prophylaxis.

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AfA Pre-ART Application

Note
The form listed below must be completed for all beneficiaries requiring registration for HIV treatment but not ART treatment.

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