firstname.lastname@example.org | (242) 396-8500
Beneﬁciary Enrolment Form
The information that you will provide is for the purposes of determining your eligibility for the National Health Insurance
(NHI) Programme facilitating enrolment and for purposes connected with the NHI Programme. Enrolment will require
the National Health Insurance Authority (NHIA) to request data and/or information from the National Insurance Board
(NIB) using the National Insurance Number provided in your application. By checking “Accept” you agree to the NHIA
requesting data and/or information from NIB for the purposes of determining your eligibility for the National Health
Insurance (NHI) Programme, facilitating enrolment and for purposes connected with the NHI Programme and further
you are providing your consent to NIB for NIB to release the information unto NHIA. The information received will be
treated as strictly conﬁdential and the NHIA will fully comply with the respective data privacy laws and policies.
The information you provide during enrolment is needed to document your enrolment in the National Health
Insurance Programme. The principal use of this information will be to:
• Identify your enrolment in the Programme;
• Verify your eligibility for health beneﬁts services, and
• Coordinate payment of claims for beneﬁts rendered under the Programme.
Please review the disclaimer above. You must check “Accept” before you can proceed. If you have any questions or
disagree with the above, contact NHI Bahamas at email@example.com.
I accept the conditions as laid out in the Enrolment Disclaimer above.
1. What you need to submit the form:
a An NIB Smart Card.
b Proof of Bahamian citizenship or legal residency.*
c Proof of residency in The Bahamas for the last 6 months.*
d Private insurance policy group ID number and Member ID number (if you have one).
e Your top 3 Primary Care Provider choices.
*Details available on www.nhibahamas.gov.bs
2. Complete the form, sign and date, and return to your local enrolment oﬃce, together with your supporting
documents. You will have to submit a separate application form for each child and any other legal dependents.
Please print clearly.