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 member registration
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.
New dependant registration
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.
Dependant child registration (age 21 up to age 25)
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.
Dependant adult registration (parent or child age 26 and over)
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
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.
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.
AfA Pre-ART Application
Note
The form listed below must be completed for all beneficiaries requiring registration for HIV treatment but not ART treatment.