CompCare MEDICAL SCHEME Begin Your Journey Follow the simple sign-up process to become a member of the CompCare Medical Scheme. "*" indicates required fields You ready? Your member application starts here. You might need to upload copies of the following documents where applicable. Identity Documents / Passports Membership certificate(s) from previous medical scheme(s) - if applicable Proof of registration at educational institution / affidavit confirming financial dependency for adult dependants 21 years and older Proof of adopted or foster children CAPTCHA Pick Your CompCare OptionFirst Name(s)* Surname* When Should Your Medical Aid Start?* YYYY dash MM dash DD What CompCare Option Are You Interested In?*Selecting an option will display a quick summary of that option below.Select OptionMedXMedX Efficiency DiscountUnisaveSelfSureSymmetrySymmetry Efficiency DiscountMumedMumed Efficiency DiscountDynamixDynamix Efficiency DiscountPinnaclePinnacle Efficiency DiscountPrerequisite For NetworX / NetworX ED ApplicationsPlease upload three of your latest salary slips, IRP5 or IT34 documents to continue with your NetworX or NetworX ED option application. Drop files here or Select files Max. file size: 32 MB. SELFSURE R3 458 per month The standard SELFSURE plan, does not limit you to specific pharmacies or hospitals. Learn more about the standard SELFSURE option.MEDX R2 150 per month The standard MEDX plan, does not limit you to specific pharmacies or hospitals. Learn more about the standard MEDX option.MEDX Efficiency Discounted (ED) R1 652 per month Similar to the standard MEDX plan, but you are limited to Dis-Chem pharmacies and Netcare hospitals. Learn more about the standard MEDX option.UNISAVE R2 585 per month The standard UNISAVE plan, does not limit you to specific pharmacies or hospitals. Learn more about the standard UNISAVE option.MUMED FROM R3 317 per month The standard MUMED plan, does not limit you to specific pharmacies or hospitals. Learn more about the standard MUMED option.MUMED Efficiency Discounted (ED) FROM R2 693 per month Similar to the standard MUMED plan, but you are limited to Dis-Chem pharmacies and Netcare hospitals. Learn more about the standard MUMED option.SYMMETRY From R4 172 per month The standard SYMMETRY plan, does not limit you to specific pharmacies or hospitals. Learn more about the standard SYMMETRY option.SYMMETRY Efficiency Discounted (ED) From R3 517 per month Similar to the standard SYMMETRY plan, but you are limited to Dis-Chem pharmacies and Netcare hospitals. Learn more about the standard SYMMETRY option.DYNAMIX FROM R5 278 per month The standard DYNAMIX plan, does not limit you to specific pharmacies or hospitals. Learn more about the standard DYNAMIX option.DYNAMIX Efficiency Discounted (ED) FROM R4 344 per month Similar to the standard DYNAMIX plan, but you are limited to Dis-Chem pharmacies and Netcare hospitals. Learn more about the standard DYNAMIX option.PINNACLE From R7 001 per month The standard PINNACLE plan, does not limit you to specific pharmacies or hospitals. Learn more about the standard PINNACLE option.PINNACLE Efficiency Discounted (ED) From R5 852 per month Similar to the standard PINNACLE plan, but you are limited to Dis-Chem pharmacies and Netcare hospitals. Learn more about the standard PINNACLE option. Your DetailsTitle*Select TitleDrMs.Mr.Mrs.Prof.Hon.Rev.First Name(s)* Surname* Initials* Phone* Email* ID Number* Race*Select RaceAfricanColouredIndian / AsianWhiteGender*MaleFemaleIncome (Rand)* Date Of Birth* MM slash DD slash YYYY Tax Number Occupation* Marital Status*Select Marital StatusSingleDivorcedMarriedWidowedCommon LawTribal LawSeparatedSmoker*YesNoMembership certificate(s) from previous medical scheme(s) Drop files here or Select files Max. file size: 32 MB. Your Address DetailsPhysical Address* Street Address City State / Province / Region ZIP / Postal Code Postal Address My Postal Address Differs From My Physical Address Postal Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Your DependantsWould you like to add dependants?*NoYesHow many dependants would you like to add to your option?*OneTwoThreeFourFive First DependantTitle*Select TitleDrMs.Mr.Mrs.Prof.Hon.Rev.First Name(s)* Surname* Initials* Phone* Email* ID Number* Race*Select RaceAfricanColouredIndian / AsianWhiteGender*MaleFemaleRelation to member* Date Of Birth* MM slash DD slash YYYY Smoker*YesNoSecond DependantTitle*Select TitleDrMs.Mr.Mrs.Prof.Hon.Rev.First Name(s)* Surname* Initials* Phone* Email* ID Number* Race*Select RaceAfricanColouredIndian / AsianWhiteGender*MaleFemaleRelation to member* Date Of Birth* MM slash DD slash YYYY Smoker*YesNoThird DependantTitle*Select TitleDrMs.Mr.Mrs.Prof.Hon.Rev.First Name(s)* Surname* Initials* Phone* Email* ID Number* Race*Select RaceAfricanColouredIndian / AsianWhiteGender*MaleFemaleRelation to member* Date Of Birth* MM slash DD slash YYYY Smoker*YesNoFourth DependantTitle*Select TitleDrMs.Mr.Mrs.Prof.Hon.Rev.First Name(s)* Surname* Initials* Phone* Email* ID Number* Race*Select RaceAfricanColouredIndian / AsianWhiteGender*MaleFemaleRelation to member* Date Of Birth* MM slash DD slash YYYY Smoker*YesNoFifth DependantTitle*Select TitleDrMs.Mr.Mrs.Prof.Hon.Rev.First Name(s)* Surname* Initials* Phone* Email* ID Number* Race*Select RaceAfricanColouredIndian / AsianWhiteGender*MaleFemaleRelation to member* Date Of Birth* MM slash DD slash YYYY Smoker*YesNo Do you have an extra moment?*I have a moment to answer some question relating to my medical historyI'll answer questions relating to my medical history at a later stageYour Medical HistoryIt is most important that the questions on the following page be answered as thoroughly as possible. The answers to these questions will be treated as confidential. It is important to note that any medical condition, of which you are aware, not disclosed in this application, can be excluded from benefit. Please advise whether you or any of your dependants suffer from, or have suffered from, or received treatment/consultation for any of the following conditions. Please ensure that you tick and complete the appropriate block/s.Heart & Vascular System*High blood pressure; high cholesterol; angina; heart attack; angiogram; previous coronary artery bypass; rheumatic fever; heart murmurs; valve problems / replacement; arrhythmias – insertion of pacemakers; heart failure; stroke; varicose veins; DVTs (deep vein thrombosis); pulmonary embolism.NoYesCondition Details* Emotional (psychological, psychosomatic problems)*Depression; bipolar disorder; anxiety; stress; previous treatment for post traumatic stress syndrome; eating disorders – bulimia & anorexia; mental retardation; alcoholism; drug abuse. Have you or any of your dependants been on sleeping tablets or antidepressants?NoYesCondition Details* Gynaecological System*Menopause; female hormone replacement; irregular menses; infertility; breast tumours (benign / malignant); ovarian tumours; cysts; prolapsed uterus / rectum / bladder; miscarriage; caesarean section; etc.NoYesCondition Details* Bone; Muscle & Joints*Arthritis; rheumatism; gout; back, knee or neck problems; fibromyalgia; previous fractures; deformities; degenerative muscle disease; osteoporosis; etc.NoYesCondition Details* Nervous System*Persistent headaches; epilepsy; paralysis; degenerative diseases – Alzheimer’s; Parkinson’s; multiple sclerosis; stroke; neuralgias; ADD (attention deficit disorder).NoYesCondition Details* Gland / Hormonal*Over / under active thyroid; diabetes mellitus; Cushing’s syndrome; Addison’s disease; pituitary gland abnormality.NoYesCondition Details* Male Genital System*Prostate problems (hypertrophy / cancer or infections); infertility; hernias – groin; scrotal swellings; testicular tumours; abnormalities of the penis; problems with urination.NoYesCondition Details* Ear, Nose & Throat*Allergies (rhinitis, sinusitis); chronic infections (otitis, tonsillitis); nasal reconstruction; snoring; sleep apnoea; deafness – hearing aids.NoYesCondition Details* Eyes*Poor vision; birth defects; degenerative disease (glaucoma; retinitis pigmentosa; cataracts; keratoconus); allergies – pterygiums; anticipated / previous laser surgery; artificial eyes.NoYesCondition Details* Pregnancy*Are you or any of your dependants pregnant? If yes - how many weeks? Please give expected date of delivery.NoYesCondition Details* Lungs*Asthma; emphysema; chronic bronchitis; TB; chronic infections - bronchitis & pneumonia.NoYesCondition Details* Urinary Tract*Infections; stones; albumin / blood in urine; urinary incontinence; prolapsed bladder.NoYesCondition Details* Blood*Anaemia; bleeding disorders (haemophilia); leukaemia; Hodgkin’s disease.NoYesCondition Details* Digestive System, Gallbladder; Liver*Dyspeptic disease (heartburn; hiatus hernia; peptic ulcers; reflux); irritable bowel syndrome (spastic colon; inflammatory bowel disease e.g. Crohn's & ulcerative colitis; chronic diarrhoea / constipation); gallstones & jaundice; hepatitis; pancreatitis; haemorrhoids; incontinence; bowel prolapse.NoYesCondition Details* Immuno-Suppressive Treatment*Have you or any of your dependants ever had or expecting to undergo an organ treatment transplant? Have you or any of your dependants ever suffered from any condition requiring Immunosuppressive treatment?NoYesCondition Details* Chronic Conditions*Do you or any of your dependants have a chronic condition requiring ongoing medication? If yes, please give the name and dosage of all the medication you or any of your dependants are currently taking.NoYesCondition Details* Medical Treatment*Are you or any of your dependants expecting to undergo any medical treatment, e.g. hospitalisation, operation, specialised dentistry etc, within the next twelve months?NoYesCondition Details* Medical Attention*Have you or any of your dependants ever received any medical attention of any nature, e.g., hospitalisation, operation, specialised dentistry etc, not mentioned above?NoYesCondition Details* Infections / Tropical Diseases*Sexually transmitted diseases; genital warts; HIV / AIDS; hepatitis; ME-Virus (Yuppie Flu); malaria; bilharzias; cholera; typhoid.NoYesCondition Details* Skin Disorders*Acne; eczema; psoriasis; lesions (keloid hypertrophic scars); skin rashes; shingles; Kaposi sarcoma – tumours.NoYesCondition Details* Allergies*Are you or any of your dependants allergic to any specific type of medication (e.g. penicillin, aspirin, sulphas, morphine, NSAIDS); pollen dust; animals; specific food types (e.g. nuts).NoYesCondition Details* Teeth & Gums*Impacted molars (wisdoms); previous / current orthodontic treatment; braces; crowns; recurrent infections - gums.NoYesCondition Details* Therapy/Treatments*Have you or any of your dependants ever received any form of physiotherapy, occupational therapy or chiropractic treatment?NoYesCondition Details* Connective Tissue Disorders*Systemic lupus erythromatosis; scleroderma; rheumatoid arthritis.NoYesCondition Details* Cancer*Cysts; growths; tumours of any kind.NoYesCondition Details* Your Payment DetailsAccount Holder* Branch Number* Bank Name* Branch Name* Account Type*CurrentSavingsTransmissionMethod Of Payment*Debit OrderDirect Payment / EFTI would like my claim refunds to be paid into a different account.*NoYesConsent* By checking this box you confirm that you have read and agree to our Terms of Service and that you have read our Privacy PolicyYour Claim Refund DetailsAccount Holder* Branch Number* Bank Name* Branch Name* Account Type*CurrentSavingsTransmissionBranch* Account Type*CurrentSavingsTransmissionMethod Of Payment*Debit OrderDirect Payment / EFTConsent* By checking this box you confirm that you have read and agree to our Terms of Service and that you have read our Privacy PolicyEmailThis field is for validation purposes and should be left unchanged.
