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SUPPORT GROUP |
Patient's First Name
Patient's Last Name
Patient's Contact Number
Patient's Home language
Age of Patient
What is your Medical Diagnosis?
Background information and reason you are needing case management support?
Which Medical Aid are you on?
Please specify your selected medical aid plan type
What is your Medical Aid Number?
Main Member Full Name
ID Number of Main Member:
Contact Number of Main Member:
Contact Email of Main Member:
Treating Doctor's full name:
Please upload all supporting documentatio related to your enquiry including Medical Aid correspondance
Review of Medical Aid Correspondance - R350
Engage in dispute with Medical Aid - R850
Ex-Gratia Application - R2500
Preparation and participation in Dispute Hearing at Medical Aid - R3000
Complaint with Council for Medical Schemes - R3500