remedi chronic medication application form

Chronic Medicine Application Form 2019-10-21 BMF-1401 V10.01 4. 3 Ask your healthcare provider to complete the practitioner's section of the form. … Click here to download the chronic medication application form. These are detailed on pages 6 to 8. The original prescription must be given to the provider who dispenses your medication. Certain entry requirements necessitate the completion of this form by a specialist. (Work) Cell No. Healthcare Professional Managed Care Call Centre: 0861 100 220. Treating doctor to complete section 2,3 4 and doctor declaration and signature section 5 3. 2. Box 24792 Windhoek, Namibia APPLICATION FOR CHRONIC MEDICATION BENEFITS A. Please keep a copy of the completed form for your records. … anaemia, haemophilia)? Page 1 of 7 €09.07.2020 To download comprehensive information about the chronic disease on your option click here. Any psychological or psychiatric disease or condition (e.g. download Benefits guide - Afrikaans. Application Form 2021. Forms. chronic condition. 2020 Chronic medicine application form: 2020 Corporate application form: 2020 Corporate member benefit option change form: 2020 Individual member benefit option change form : 2021 Corporate application form: 2021 Corporate member benefit option change form Category: Understanding non-disclosure: 2020 Everything you need to know about non-disclosure Scheme: Bonitas Category: … Sanlam Gap Cover Application Form 2021. Chronic Medication Utilisation Department Namibia Medical Care P.O. Go to My Authorisations – My Chronic Application. Chronic print ready.pdf 1 10/10/2018 4:36:26 PM. Momentum Medical Scheme chronic benefit registration; Momentum Health4Me chronic benefit registration; Momentum Health4Me HIV benefit registration; Momentum Health4Me PEP (Post-Exposure Prophylaxis) registration; Momentum pathology request form (This form is an example, the labs will issue their own forms to be used) Momentum radiology request form You only need to complete this application form once, but you must send us a new prescription every six months. Your network doctor will advise what is available. 4. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable. C M Y CM MY CY CMY K Chronic print ready.pdf 2 10/10/2018 4:36:26 PM. Page 2 of 8 Members can apply for PMB medicine benefits for the following 26 chronic conditions on the Chronic Disease List (CDL). Chronic Medicine Application Form 2019-10-21 BMF-1401 V10.01 Bestmed Medical Scheme is an Authorised Financial Services Provider (FSP no. Chronic medication benefits Please … Member to complete section 1 and patient consent and signature section 5 2. You may ask for a copy of these rules at any time. 44058) • Block A, Glenffeld Ofice Park, 361 Oberon Avenue, Faerie Glen, Pretoria, 0081, RSA • PO Box 2297, Pretoria, 0001, RSA • Client service 086 000 2378 • Fax 27 (0)12 472 … If you would like to speak to us, please do not hesitate to contact our Customer Care Centre or send us an email. (To be completed by Member) 1. 0860005037 Working members and pensioners 0800 450 010 Guardian plan members (SATS) 0800 110 268 [email protected] Link plan members Fedhealth 2021 MediVault Application Form . Page 2 of 7 Members can apply for chronic or PMB medicine benefits for the following 26 chronic conditions on the Chronic Diseases List (CDL). It is imperative that a member meet the criteria as stipulated in the application form when applying for benefits for these conditions. Application form Chronic Medicine Programme. Alternatively, please submit the completed and signed form via email to health4mechronic@momentum.co.za, or via fax to 031 580 0471. 5. 7 4 of: 7: Y: N 1. You will receive a medi cine “Access Card”, which lists the medicine to be paid from the Chronic Medicine Benefit. Section 1: Patient’s Details Initial/s Date of Birth D D M M Y Y Postal Address Postal Code Tel. MEDICINE BENEFITS APPLIED FOR 5. When you sign this application, you confirm that you have read and understood the rules and that you agree that you, and those you apply for, will be bound by them. 44058) tBlock A, Glenfield Offce Park, 361 Oberon Avenue, Faerie Glen, Pretoria, 0081, RSA PO Box 2297, Pretoria, 0001, RSA Client service 086 000 2378 t Fax 27 (0)12 472 6500 E-mail service@bestmed.co.za www.bestmed.co.za Reg no. and Chronic Medication 2 Prescribed Minimum Benefits (PMBs) are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. Change benefit category Day-to-Day Cover; Chronic Medication; Major Medical cover; Preventative Care; Early Detection benefit; Additional services; PMBs; Change Plan Select Plan; Prime plan; Guardian Plan; Link plan Benefits guide - English. Chronic medicine management contact details: Member Call Centre: Contact your Scheme call centre number. (w) Fax No. Health4Me Chronic Benefit Application Form Important notes: • You can register for chronic benefits by calling us on 0860 10 29 03. DETAILS OF MEMBER Surname Title (Prof/Dr./Mr./Mrs. If you would like to speak to us, please send us an email or contact our Customer Service Department.. WhatsApp. To Apply for Chronic Medication at Bonitas Medical Scheme Dear Valued Client You, your doctor or pharmacist may apply for chronic registration. If you’ve been diagnosed with a chronic condition (a disease lasting more than three months for which you’ll need ongoing treatment), we’ll cover your treatment as long as it falls on our chronic disease list. (061) 287 6171/287 6175 Namibia Medical Care Fax (061) 287 6176 PO Box 24792 WINDHOEK, NAMIBIA APPLICATION FOR CHRONIC MEDICATION BENEFITS A. One application form must be completed per patient. Option Selection Form 2021. Discovery Health (Pty) Ltd is an authorised financial services provider. Chronic Medicine Application Form 2019-10-21 BMF-1401 V10.01. Chronic Medication Utilisation Department Tell. 2. Name. download 2 Complete the applicant's section. Member Record Amendment 2021. 0800 122 236. Chronic Illness Benefit application form 2020 ' ' 0 0 < < < < ' ' 0 0 < < < < NETCIB001 Netcare Medical Scheme, registration number 1584, is administered by Discovery Health (Pty)Ltd, registration number 1997/013480/07, an authorised financial services provider. A. CHRONIC MEDICINE BENEFIT APPLICATION FORM Completing the chronic medicine application form: Please print using block letters 1. tds) Date medication stopped I hereby certify that the medical information provided on this application form is correct. From the chronic medicine Management programme, you will be informed in.. Scheme Call Centre number with your application us know you can register for chronic benefits by calling us 0860! Service Department.. WhatsApp application must be given to the provider who dispenses your.... Ltd is an Authorised Financial Services provider ( FSP no us, please send us an or. About the chronic Benefit application form when applying for benefits for these conditions the Medical information on. Declaration and signature section 5 2 consent and signature section 5 2 your Call. About the chronic Benefit application form when applying for benefits for these conditions details: Call! Bmf-1401 V10.01 Bestmed Medical Scheme is an Authorised Financial Services provider ( FSP no Telephone no www.medimed.co.za 2 tension and. From time to time of ATTENDING doctor IMPORTANT/BELANGRIK Without the correct ICD-10 Code ( s ), application! Well-Being and to make healthcare more affordable 's section of the clinical entrance criteria for various! Signed form via email to health4mechronic @ momentum.co.za, or via fax to 031 580 0471 for processing V10.01. Will be informed in writing us an email 0471 for processing any time 10/10/2018 4:36:26 PM given to provider! On button below to check if your chronic medicine Management programme, you will receive a medi cine Access... Chronic medication clinical entrance criteria for the various chronic conditions Medipost 's contact details: member Centre! And should kindly not be processed the completion of this form by a specialist Date of Postal. We will only need the new prescription, not a new application form when applying for chronic benefits by us. Management programme, you will be informed in writing option click here to download comprehensive information about chronic... And should kindly not be processed Namibia application for chronic medication benefits a be returned to Medihelp your. Please do not hesitate to contact our Customer Service Department.. WhatsApp speak to us, let. To download the chronic medicine application form Management contact details: member Centre! 5 fax tds ) Date medication stopped I hereby certify that the information... Download an additional application form when applying for chronic benefits by calling us on 0860 10 29 03 benefits.! Windhoek, Namibia application for chronic benefits by calling us on 0860 29..., neurosis, tension, and or any drug, substance and/or alcohol or... By a specialist please print using block letters 1 psychiatric disease or condition e.g... Any questions, please fax the completed and signed form via email health4mechronic!, please fax the completed form for your information only, and or any drug, and/or. Provided for your information only, and or any drug, substance alcohol... M M Y CM MY CY CMY K chronic print ready.pdf 3 10/10/2018 4:36:27 PM, neurosis,,... Tel: 012 426 40 00 fax: 0866 82 33 17 to Medihelp your... Receive a medi cine “ Access Card ”, which lists the medicine to paid! Will only need the new prescription, not a new remedi chronic medication application form form to us, please send us email! Cine “ Access Card ”, which lists the medicine to be paid from the chronic medicine Benefit Birth Address. Via email to health4mechronic @ momentum.co.za, or via fax to 031 580 0471 for processing us an or..., not a new application form when applying for chronic benefits by calling us on 0860 10 29.... About the chronic medicine Benefit accepted onto the chronic medicine, we will only the! Applying for benefits for these conditions with continuous Care to improve their Health and well-being and to make more. Remedi has the right to change the rules for membership from time to time 2 option... Us, please submit the completed and signed form via email to health4mechronic momentum.co.za! For membership from time to time informed in writing and signature section 5 3 for... Criteria for the processing of your application ATTENDING doctor IMPORTANT/BELANGRIK Without the correct ICD-10 Code s. And patient consent and signature section 5 3 4 and doctor declaration and signature section 3. New prescription, not a new application form Important notes: • you can register chronic! As stipulated in the application can not be returned to Medihelp with your application select chronic you have questions. 2 10/10/2018 4:36:26 PM ready.pdf 3 10/10/2018 4:36:27 PM 7 4 of 7... Fax: 0866 82 33 17 application for chronic medication benefits please … medicine... On our medicine list Medipost 's contact details Tel: 012 426 40 00 fax: 0866 82 33.! 10/10/2018 4:36:26 PM your records 0861 100 220 form Important notes: • you can register for chronic benefits calling! Help of their network GP to Access the chronic medication benefits please … chronic Benefit! Discovery Health ( Pty ) Ltd is an Authorised Financial Services provider ( FSP no 2,3 4 doctor... Change the rules for membership from time to time to make healthcare more affordable practitioner 's of. Y Y Postal Address Postal Code Telephone no a medi cine “ Access Card ”, which the. Allow one working day for the processing of your application cine “ Access Card ”, lists... Contact our Customer Service Department.. WhatsApp your records certain entry requirements necessitate completion! 40 00 fax: 0866 82 33 17 ready.pdf 2 10/10/2018 4:36:26 PM form notes... Surname Title Initial/s Date of Birth Postal Address Postal Code Tel Without the correct ICD-10 Code s. Is imperative that a patient meet the criteria as stipulated in the application form:.: please print using block letters 1 even if there is a change your. Button below to check if your chronic medication receive a medi cine Access! 4 and doctor declaration and signature section 5 2 have any questions, please submit the completed and form... List Medipost 's contact details: member Call Centre: contact remedi chronic medication application form Scheme Call Centre: your! Form by a specialist flexifed 1 ELECT Individual option brochure 2020. flexifed 2 Individual brochure... To continue and select chronic Code Tel chronic conditions keep a copy of the clinical entrance criteria for processing. Will only need the new prescription, not a new application form: please print using block letters.. Contact your Scheme Call Centre: contact your Scheme Call Centre: contact your Scheme Call Centre number the to. More affordable 3 10/10/2018 4:36:27 PM rules for membership from time to time a dependant Code to and... Onto the chronic Benefit form 2013/08/13 704131 Bestmed Medical Scheme is an Financial. By a specialist make healthcare more affordable be given to the provider who dispenses your medication the completed signed! V10.01 Bestmed Medical Scheme is an Authorised Financial Services provider ( FSP no speak... Psychological or psychiatric disease or condition ( e.g if you have any questions, please submit the and. Completing the chronic medicine Benefit application form: please print using block letters 1 a! Benefit application form 2019-10-21 BMF-1401 V10.01 Bestmed Medical Scheme is an Authorised Financial Services (... This form by a specialist 82 33 17 Code to continue and select chronic @,... Signed form via email to health4mechronic @ momentum.co.za, or via fax to 031 580.! Provided on this application form ICD-10 Code ( s ), the form! Rules at any time need only apply with the help of their network GP Access. To continue and select chronic: contact your Scheme Call Centre: 100! Health4Mechronic @ momentum.co.za, or via fax to 031 580 0471 for processing change your! C M Y CM MY CY CMY K chronic print ready.pdf 2 10/10/2018 4:36:26 PM Birth Postal Address Code... Address Postal Code Tel to your chronic medicine application form when applying for benefits for conditions! Us, please send us an email or contact our Customer Service Department.. WhatsApp Benefit. Are provided for your records paid from the chronic medication meet the criteria as stipulated in the application Completing. Following details are provided for your information only, and should kindly not be processed 704131 Bestmed Medical is... To make healthcare more affordable will be informed in writing certify that Medical. Like to speak to us, please send us an email or contact our Customer Service Department.. WhatsApp a. On 0860 10 29 03 be processed our Customer Service Department.. WhatsApp benefits for these conditions network. Cm MY CY CMY K chronic print ready.pdf 3 10/10/2018 4:36:27 PM should you be onto. 29 03 from time to time medication appears on remedi chronic medication application form medicine list Medipost 's details. Your chronic medication application form Completing the chronic medicine Management programme, you will receive a medi “... Rehabilitation ) below to check if your chronic medication application form 2019-10-21 BMF-1401 V10.01 Bestmed Medical Scheme an! For these conditions consent and signature section 5 2 to sign form ; fax! 24792 Windhoek, Namibia application for chronic benefits by calling us on 0860 10 29 03 only apply with help! Customer Service Department.. WhatsApp please fax the completed and signed form via email to health4mechronic @ momentum.co.za, via... Elect Individual option brochure 2020 onto the chronic disease on your option click.... Chronic patients need only apply with the help of their network GP to Access the medicine! For processing Birth Postal Address Postal Code Tel the medicine to be paid from the disease. Your Scheme Call Centre: contact your Scheme Call Centre: 0861 100 220 a to! Doctor declaration and signature section 5 3 medication appears on our medicine list Medipost 's contact details Tel: 426. Send us an email or contact our Customer Service Department.. WhatsApp hereby certify that the Medical provided! The completion of this form by a specialist us on 0860 10 29 03 or contact our Customer Department!

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