GEMS MEDICAL AID QUOTE
What the plans cost.
ONLY FOR GOVERNMENT EMPLOYEES!

help with medical aidPlease complete and send to me.
Get a quote on all the GEMS Medical Aid plan options,
rates and information you need.


DO YOU HAVE TO JOIN YOUR EMPLOYER'S MEDICAL AID?
YES or NO

ONLY HOSPITAL COVER?
YES or NO WANT DOCTOR, DENTIST, CHEMIST, GLASSES AS WELL

NAME

EMAIL

TEL

CITY

HOW MANY ADULTS

YOUR AGE

PARTNER'S AGE

HOW MANY CHILDREN

YOUR CURRENT MEDICAL AID AND PLAN

TOTAL YEARS IN YOUR LIFE YOU HAVE BEEN A MEDICAL AID MEMBER

AND YOUR PARTNER

HOW MUCH CAN YOU AFFORD EACH MONTH

ANY CHRONIC CONDITIONS

WHAT DO YOU WANT FROM A MEDICAL AID

Receive my informative letter on personal financial matters? Yes

Please note:

I confirm that I have read and understood the notes above.Yes

Exclusions and sub - limits apply, see brochures.

helpINVESTIGATE OTHER MEDICAL AIDS!

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2017