Online Application

Please enter your details and select "Search Application" to continue capturing your application or "New Application" to begin with your membership application. If you have already started your application please remember to complete it within 4 days.
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Online Application

Consent for Medshield Medical Scheme To Process Personal Information

The Scheme understands that your personal information and that of your dependants is important to you. Medshield undertakes to keep this information confidential and shall take all reasonable steps to comply with the provisions of legislation protecting your personal information. We require your consent to obtain process and disseminate your personal information in order to provide you the service as contemplated by our contractual agreement set out in your chosen benefit in compliance to the Medical Schemes Act 131/1998, which entails but not limited to:

  1. Treatment Authorisations;
  2. Claim Assessment;
  3. Claims payment;
  4. Communication;
  5. Disease Management;
  6. Wellness Initiatives.

While your consent is voluntary, it is a requirement for the administration of your Medshield membership. If you object to the processing of your personal information, then the Scheme will not be able to activate and service your membership. Please read and accept the important terms and conditions relating to protection of your personal information

 I agree to the terms and conditions
Member Disclaimer

Please read and accept the member acknowledgement and declaration

 I agree to the terms and conditions
Enter Code
     

Medical Option

Step 1 of 10

 
Note

If you choose, MediCurve, MediPhila, MediValue Compact or MediPlus Compact, it is compulsory for you and your dependants to nominate a Family Practitioner. Download FP nomination form in order to complete this and upload under the Supporting Documents step of your application.

Main Member

Step 2 of 10

Dependants

Step 4 of 10

Main Member Contact Information

Step 5 of 10

Note

Cellphone number and email address are mandatory fields to be completed

Address

Step 3 of 10

Residential Address
Tick if postal address is the same as the street address
Postal Address

Banking Details

Step 6 of 10

Note: Please note that monthly contributions are paid in advance

I hereby authorise Medshield Medical Scheme to deduct my monthly contributions and/or pay refunds to the following bank account. Should the bank details provided not be that of the main member of the Scheme, a stamped bank statement together with a signed letter of authorisation from the account holder is required. If bank details are in the name of an Organisation/Company a stamped bank statement or a stamped confirmation letter from the bank together with a 'Letter of Authorisation' on company letterhead is required.

 I hereby give Medshield Medical Scheme the authority to verify the bank details provided.
Submit your supporting documents in Step 9: Supporting documents
Debit order authority
Claim refunds
Tick if both the Debit order authority and Claim refunds accounts should be the same

Medical Conditions

Step 8 of 10

Note

All conditions, symptoms and or disorders have to be declared, no matter how insignificant they may seem. Incomplete, inaccurate information or information that is withheld may result in the termination of your membership effective from date of registration. If you answer Yes to any of the questions please provide full details. If you do not have any conditions to declare, please move to the next section. More than one (1) condition may be applicable to a question, if so, you need to reselect the question in order to complete additional information. Failure to disclose or register dependants living with HIV with Lifesense (0860 50 60 80) within 21 days will be considered as non-disclosure and may result in termination of your membership.

Preview and Submit...

Step 10 of 10

Dependants
Address
Banking
Previous Medical Aid (Optional)
Medical Conditions (Optional)

Please ensure your supporting documents are uploaded (Step 9 - Supporting Documents) prior to submission in order to ensure efficient processing.

Previous Medical Aid

Step 7 of 10

Note

Please provide details and proof of all previous registered South African medical schemes you and your dependants belonged to (proof in the form of membership certificates reflecting the join and end dates, must be uploaded in Step 9). This information is used to determine waiting periods and or late joiner penalties.

Supporting Documents

Step 9 of 10

To help us process your application as quickly as possible, please ensure that you have included the following with your application.

  • Copy of ID / Birth certificate / passport
  • Stamped Bank Statement not older than 3 months (name and account holder must be clear)
  • Membership certificate from previous medical scheme and or affidavit if the Scheme is no longer in existence, indicating the name of the Scheme, beneficiary details and period of membership.

  • Stamped Bank statement not older than 3 months (name and account holder must be clear)
  • Signed letter of authorisation from account holder
  • If bank details are in the name of an Organisation a stamped bank statement or a stamped confirmation letter from the bank together with a signed 'Letter of Authorisation' by the company’s director, HR or financial manager on a company letterhead is required. Cipro documents may be submitted in the event that the main member is one of the directors.

  • Copy of ID / Birth certificate / passport
  • Copy of marriage certificate / Divorce decree
  • Membership certificate from previous medical scheme and or affidavit if the Scheme is no longer in existence, indicating the name of the Scheme, beneficiary details and period of membership.
  • Consent form from Spouse, Life partner or divorced spouse

  • Copy of ID / Birth certificate / passport
  • A declaration confirming reason for difference in surname (biological child)
  • Proof of legal adoption
  • Legal documentation pertaining to the foster of the child
  • Proof of study from a recognised tertiary institution for dependants turning 21 within the next 3 months
  • Membership certificate from previous medical scheme, if applicable
  • Consent forms from dependants over the age of 18

  • Copy of ID / Birth certificate / passport
  • Proof of study from a recognised tertiary institution
  • A declaration confirming reason for difference in surname (biological child)
  • Proof of income (of the dependent) or
  • Legal documentation if child is adopted.
  • Legal documentation pertaining to the foster of the child
  • For mental or physical disability;
  • Proof of disability from a medical practitioner (a medical assessment report completed by a medical practitioner)
  • Membership certificate from previous medical scheme, if applicable
  • Consent forms from dependants over the age of 18

  • Copy of ID / Birth certificate / passport
  • Certified affidavit from main member confirming parent resides and is financially dependant on him/her
  • Proof of income / pension of the parent
  • Membership certificate from previous medical scheme and or affidavit if the Scheme is no longer in existence, indicating the name of the Scheme, beneficiary details and period of membership.
  • Consent form from parent(s), in laws

  • Copy of ID/Birth certificate or Passport
  • Certified affidavit from the main member stating the child resides and is financially dependant on the main member
  • Certified affidavit from the parents confirming residency of the dependant, employment status and income of the parent and granting permission for dependant to be added onto the main member’s medical aid
  • Proof of income of the parent (s) – Payslip / bank statement
  • Death Certificate (if parent(s) of the child is deceased)
  • Proof of previous medical Aid
  • Legal documents for custody of the child
  • Membership certificate from previous medical scheme, if applicable
  • Consent form from parents (link to form)
  • Proof of study from a recognised tertiary institution for dependants between the age of 21 and 27 and for dependants turning 21 within the next 3 months.
  • Consent form from dependants over the age of 18
  • Consent forms from parents for dependants younger than 18
Document
Accepted document types: jpg, png, pdf, tiff, bmp, gif. File size < 5MB

Alternatively email your supporting documents to newapplication@medshield.co.za should you want to submit a document that does not conform to the above upload restrictions. Please include the main member's ID number as a reference.