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Medical Aid Quote
Information
Compulsory to complete fields marked with *
Name and Surname*
Date of Birth*
Email address*
Contact Number*
Province*
-- Select Province --
Eastern Cape
Free State
Gauteng
Kwazulu Natal
Limpopo
Mpumalanga
North West
Nothern Cape
Western Cape
Spouse
No
Yes
Number of children under the age of 21
0
1
2
3
4
5
6
7
8
9
10
Number of children between 21 and 27 who are studying
0
1
2
3
4
5
6
7
8
9
10
Number of children between 21 and 27 who are not studying
0
1
2
3
4
5
6
7
8
9
10
Previous Medical Scheme Information
I HAVE NO PREVIOUS MEDICAL AID
NAME OF MEMBER
NAME OF SCHEME
MEMBERSHIP NUMBER
DATE JOINED
DATE TERMINATED
CHOOSE THE SCHEME
AECI MEDICAL AID SOCIETY
AFROX MEDICAL AID SOCIETY
ALLIANCE MIDMED MEDICAL SCHEME
ALTRON MEDICAL AID SCHEME
ANGLO MEDICAL SCHEME
ANGLOVAAL GROUP MEDICAL SCHEME
BANKMED
BARLOWORLD MEDICAL SCHEME
BESTMED MEDICAL SCHEME
BMW EMPLOYEES MEDICAL AID SOCIETY
BONITAS MEDICAL FUND
BP MEDICAL AID SOCIETY
BUILDING & CONSTRUCTION INDUSTRY MEDICAL AID FUND
CAPE MEDICAL PLAN
CHARTERED ACCOUNTANTS (SA) MEDICAL AID FUND (CAMAF)
COMMUNITY MEDICAL AID SCHEME (COMMED)
COMPCARE WELLNESS MEDICAL SCHEME
DE BEERS BENEFIT SOCIETY
DISCOVERY HEALTH MEDICAL SCHEME
ENGEN MEDICAL BENEFIT FUND
FEDHEALTH MEDICAL SCHEME
FISHING INDUSTRY MEDICAL SCHEME (FISH-MED)
FOOD WORKERS MEDICAL BENEFIT FUND
GENESIS MEDICAL SCHEME
GLENCORE MEDICAL SCHEME
GOLDEN ARROWS EMPLOYEES' MEDICAL BENEFIT FUND
GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS)
GRINTEK ELECTRONICS MEDICAL AID SCHEME
HORIZON MEDICAL SCHEME
HOSMED MEDICAL AID SCHEME
IMPALA MEDICAL PLAN
IMPERIAL GROUP MEDICAL SCHEME
KEYHEALTH
LA-HEALTH MEDICAL SCHEME
LIBCARE MEDICAL SCHEME
LIBERTY MEDICAL SCHEME
LONMIN MEDICAL SCHEME
MAKOTI MEDICAL SCHEME
MALCOR MEDICAL SCHEME
MASSMART HEALTH PLAN
MBMED MEDICAL AID FUND
MEDIHELP
MEDIMED MEDICAL SCHEME
MEDIPOS MEDICAL SCHEME
MEDSHIELD MEDICAL SCHEME
METROCARE
METROPOLITAN MEDICAL SCHEME
MOMENTUM HEALTH
MOTOHEALTH CARE
NASPERS MEDICAL FUND
NEDGROUP MEDICAL AID SCHEME
NETCARE MEDICAL SCHEME
OLD MUTUAL STAFF MEDICAL AID FUND
PARMED MEDICAL AID SCHEME
PG BISON MEDICAL AID SOCIETY
PG GROUP MEDICAL SCHEME
PICK N PAY MEDICAL SCHEME
PLATINUM HEALTH
PROFMED
QUANTUM MEDICAL AID SOCIETY
RAND WATER MEDICAL SCHEME
REMEDI MEDICAL AID SCHEME
RESOLUTION HEALTH MEDICAL SCHEME
RETAIL MEDICAL SCHEME
RHODES UNIVERSITY MEDICAL SCHEME
SABC MEDICAL AID SCHEME
SAMWUMED
SASOLMED
SEDMED
SELFMED MEDICAL SCHEME
SISONKE HEALTH MEDICAL SCHEME
SIZWE MEDICAL FUND
SOUTH AFRICAN BREWERIES MEDICAL SCHEME
SOUTH AFRICAN POLICE SERVICE MEDICAL SCHEME (POLMED)
SPECTRAMED
SUREMED HEALTH
TFG MEDICAL AID SCHEME
THEBEMED
TIGER BRANDS MEDICAL SCHEME
TOPMED MEDICAL SCHEME
TRANSMED MEDICAL FUND
TSOGO SUN GROUP MEDICAL SCHEME
UMVUZO HEALTH MEDICAL SCHEME
UNIVERSITY OF KWA-ZULU NATAL MEDICAL SCHEME
UNIVERSITY OF THE WITWATERSRAND - JOHANNESBURG STAFF MEDICAL AID FUND
WITBANK COALFIELDS MEDICAL AID SCHEME
WOOLTRU HEALTHCARE FUND
Other
Add another Scheme
Are you changing your medical scheme due to a change in employement?, if yes please provide a proof of change of employement.(Closed Schemes members only)
Yes
No
MEDICAL DETAILS QUESTIONNAIRE
FAILURE TO DISCLOSE PRE-EXISTING CONDITIONS COULD LIMIT AND/OR EXCLUDE CERTAIN BENEFITS OR RESULT IN TERMINATION OF YOUR MEMBERSHIP
Did you or any of your dependents have any of the following operations, medical conditions or disorders during the past 12 months or received treatment, advice and/or medication for any of them. Please tick "Yes" or "No"
1. Diabetes, Heart Disease, Stroke, Cancer, Irregular menstruation cycle/abnormal menstrual bleeding, Hypertension and Cholesterol? *
Yes
No
2. Taking medicine on an on-going basis or reasonably expecting to take medicine in the next 12 months? *
Yes
No
3. Had any operations or admission to any hospital in the last 12 months? *
Yes
No
4. Awaiting or planning any operation or admission to hospital (including pregnancy) for treatment in the next 12 months? *
Yes
No
5. Is there any other condition or symptom, not detailed in any question above, for which medical advice, diagnosis, care or treatment has already been recommended or received, or could potentially result in a medical claim within 12 months? *
Yes
No
ADDITIONAL INFO
Please let us know where did you hear about KeyHealth Medical Scheme?
-- Please Select --
Events
Inbound Call to Client Services
Inbound Call to Scheme
Other
Rugby
Social media
TV Advertisement
Website
Word of mouth
Please Select Event
-- Please Select --
Curro Schools events
Moon Chaser Night Trail Running events
Varsity Cup / Varsity Sports events
Warrior Race events
Other
Please Specify
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