Get your quote today… Request a quoteLet us assist you in getting the best quote for your lifestyle… Request for Quotation Name * First Last * Last ID Number * Email * Physical address * Postal address * Contact number * Alternative number Monthly income * How many people need to be covered * Age of adult dependants * Separate ages with a comma (,) Ages of children Separate ages with a comma (,) Age of full-time enrolled student Separate ages with a comma (,) Already have medical aid? * Yes No If yes, where? What option? For how many years was the main member and adult dependants registered with a SA Medical Aid? Respond wth (0) if main member has never belonged to a medical aid. Looking at a specific new Medical Scheme? Let us know whether you have investigated other medical aids, funds or hospital plans that you may be interested in. Type of medical aid required: * Hospital plan only Capitation plan; Income based, netwerk option with basic health care Hybrid plan with savings for day to day outside hospital use What you don’t use you don’t lose Traditional plan; What you see is what you get. What you don’t use you lose Gap Cover in hospital short fall cover Conditions and special needs: Chronic conditions? Specific needs? Any other information? Details of any chronic conditions or specific needs and/or other information: If you are human, leave this field blank. Submit