+27 860 102 936 info@medgaponline.co.za

Bonitas 2025 application form

2025 BONITAS APPLICATION FOR:
UNDER 30 / SINGLE / FAMILY COVER / PENSIONER / STUDENT

Thank you for deciding to apply for gap insurance cover with MedGap, underwritten by Guardrisk Insurance Company Limited (Reg. 1992/001639/06, FSP No. 75). This document is an application form for cover. Please complete the form accurately and completely in order that we may process your application.

Contact us

Tel: 012 880 2230, Email: info@medgaponline.co.za

What you must do

1. Fill in the form.

2. Submit your application by emailing the form to us at new@medgaponline.co.za, with your medical aid membership certificate and proof of previous gap cover (if you are moving your cover from another insurer to us).

Once you have submitted your application form:

• If any details are missing or we need more information, we will contact you.

• We will activate your membership and we will email you a confirmation of cover, along with your policy wording.

• If you do not hear from us 2 weeks after sending us your application, please contact us on 012 880 2230 or email new@medgaponline.co.za

When you sign this application, you confirm that you have read and understood the terms and conditions of cover and agree to them.

2025 APPLICATION FOR BONITAS
  • COVER OPTION
  • ABOUT YOUR HEALTH
  • BENEFICIARY DETAILS
  • BANKING DETAILS
  • PERSONAL INFORMATION
  • DEPENDANTS
  • WHO IS COMPLETING THIS FORM
  • YOUR DECLARATION
  • PREVIOUS GAP COVER
0% Complete
1 of 9

PLEASE SELECT YOUR COVER OPTION

UNDER 30 (Single Member Age 18-29)
SINGLE COVER (Single Member Age 30-64)
FAMILY COVER (Main Member Age 30-64)
PENSIONER COVER (Main Member Age 65+)
STUDENT COVER (Single Member Age 18-28)

The Student Gap product is only available for full-time students registered at a recognized Tertiary Educational facility and provides cover for the principal member only (no dependents may be covered)

The monthly premium is inclusive of commission, binder fees and VAT. Premiums are valid for 2025. Prices may increase from 1 January 2026.

Cover can only start on the first day of the calendar month following application. No requests for backdating of cover will be considered.