Trulogic Financial Services | Medical Aid Quick Quote Form

Quick Quote

Your Name *

Mobile Phone Number *

Landline Phone

Your Email Address *

What is the Age of the Main Member *

This will be the person in who's name the Medical Aid Policy will be

What is the Monthly Income of the Main Member? *

Please tick the option below that is applicable to whoever will be the main member *

This question applies to any medical aid scheme

I am currently on a Medical Aid and have been for longer than 2 years

I am currently on a Medical Aid but for less than 2 years

I have not been on a Medical Aid for the last 3 months

What is the name of the medical aid scheme that the main member is currently on? *

Do any of the members you want to add have any chronic conditions? *

Yes

No

How important is day to day benefits to you? *

Things like Optometry, Dentist and GP visits. (Medical Aid options with these included are typically more expensive)

I am not really concerned about these benefits

I would like to have it covered if I can afford it

It is very important to me

Indicate your Hospital provider preference *

Using network or state providers is typically cheaper.

I want to be able to go to any hospital I choose

I am happy to use the schemes private network hospitals

I will go to a state hospital if needed to get the cheapest medical aid

City or Town you live in? *

We need this to check if there are network service providers in your area or if we can recommend Coastal or other area type options to you.

You can give more info on any chronic conditions if you want.

Is there anything else you think we should know?