Medimas Affiliation Form: Format, Filling and MORE

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Do you want to know how to manage the Medimas Affiliation Form? Continue reading this article so that you can correctly complete the information required by the EPS.

Here you will find the recommendations for filling out the Form, the fields that must be completed, what this Form is for, what Medimas is, what are the benefits it offers and much more information.

Medimas Membership Form Format

The Format of the Medimas Affiliation Form it is quite extensive. It consists of two (2) parts, therefore, it is necessary to take into account some aspects to be filled out. These are as follows:

  • It must be managed with a black ink pen.
  • Absolutely all the spaces of the Medimas Affiliation Form are mandatory.
  • Complete the fields without deletions or amendments.
  • Mark the fields with an X.
  • Incorporate all members of the family.
  • Use the support table to verify the codes required.
  • Lean on one of the office advisers.
  • Review the instructions through Medimas web portal.

Filling out the Medimas Membership Form

Medimas has at its disposal a manual for the proper management of the Medimas Affiliation Form and the Registry of News to the General System of Social Security in Health (SGSSS). Said Form has eleven (11) parts, where the data of the person who is going to contribute, the members of his family and information of the contributor must be processed:

Chapter No. 1. The Processing Data

This information has to do with the characteristics of the transaction or management carried out through the registration of the Medimas Affiliation Form and the News Report. For this reason, they are mandatory for the person who contributes, the head of the family. In this section you will find other fields of interest:

The Type of Procedure

Depending on the procedure that the interested party is going to carry out, they have to mark one of the alternatives. In the case of entering the SGSSS for the first time, as a contributor, head of family, beneficiary or extra affiliate, you must select the alternative Affiliation.

On the other hand, in the event that the user is going to communicate any change in their general information, room address, members of the family group (exclusion or inclusion), or in the data of work connections, the alternative Report of What’s new.

The Regime

This field must be managed according to the data that appears in the Security and Guarantee Fund (FOSYGA), or on the basis of the information provided by the State to make this review. Take into account that if the user uses mobility, his regimen will not change. The regimes are:

  1. The Tax: It is used in the users who are in the Contributive regime, and are going to make some novelty in it, and for users who enjoy the Sisben level allowed, to do the Mobility between Regimes.
  2. Subsidiary: It is used by users who are in the Subsidized Regime, and they are going to make something new in it.

Affiliate Type

It refers to the situation of the person who makes the affiliation or communicates the news. These are divided into:

  • The contributor: It is when the individual who joins or communicates the news, by obligation must contribute to the SGSSS (General System of Social Security in Health) in the Tax Regime.
  • Family boss: In this case, the individual who joins or communicates the news registers or has registered as head of his / her family group in the Subsidized Regime.
  • The Beneficiary: It is the individual that makes up the family group and gather the qualities to be registered as beneficiary of a contributor within the Contributory Scheme, or of a head of the family in the Subsidized Scheme.

Type of contributor

The alternative must be selected according to the type of employment relationship with which the user go to make connection to the Health Promotion Entity (EPS). The relationships are mentioned below:

  1. Dependent Relationship: When the contributor has an employer through an employment relationship and divide with it the payment of the fees to pension and health.
  2. The Independent Relationship: In this case, the contributor has no connection with an employer through an employment relationship, for this reason, he does not distribute the payment of fees, instead he pays them in full.
  3. Pensioner Relationship: It is when the contributor enjoys a pension and the cancellation of the health payments are under his responsibility.

The code

This field belongs to the contributor code stipulated in the current affiliate database.

Chapter N ° 2. Basic Identification Information (both the contributor and the head of the family)

In these spaces you have to manage the general information of iidentification of the contributor or the head of the family. It must be in the same way as shown in the identification document. Here is the following space:


Consideration should be given to the type of document of identy, according to the list detailed below with their respective codes:

  • The Birth certificate (CN).
  • Civil birth registration (RC).
  • The identity card (TI).
  • Citizenship card (DC).
  • The immigration card (CE).
  • The passport (PA).
  • Diplomatic card (CD).
  • The residence permit (SC).

Chapter N ° 3. Complementary Information

This information must be registered for the person who is listed in the Contributory Scheme and for the head of the family in the corresponding Subsidized Scheme. These spaces are the following:

The ethnic group

Here the relevant code for ethnicity is described, in the event that it belongs to any of those shown in the table below:

  1. Indigenous Ethnicity, code 01.
  2. The Rrom ethnic group (gypsy), code 02.
  3. Raizal ethnic group (San Andrés y Providencia), code 03.
  4. The Palenquero ethnic group (San Basilio del Palenque), code 04.
  5. Ethnic Black (a), Afro-Colombian (a), code 05.


This field is only managed if the contributor or head of the family have a known disability and is medically qualified.

The SISBEN Score

This information is used only for the Subsidized Regime. You have to record the score obtained in the SISBEN survey.

NOTE: Take into consideration that, for the entry base contribution spaces – IBC, the cell phone number and the email address when managing the Form.

Chapter N ° 4. Identification Information of the Members of the Family Group. Basic Identification Information of the Partner or Stable Contributing Spouse

This information has to be registered only when the partner or stable spouse, contributes to the SGSSS. In the event that this is not listed, you have to register in the fields of «Identification data of the members of the family nucleus».

It should be clarified that space 29 «Relationship» It has to be completed as shown in the list below, with its respective code:

  • The spouse (CY).
  • The stable partner, taking into account same-sex couples (CP).
  • Children under 25 years of age (HI).
  • Children of any age (HD).
  • The children of the partner or stable spouse of the member, taking into consideration the same-sex couples (HC).
  • Children of the beneficiaries (HB).
  • Under 25 or of any age who have a permanent disability (MD).
  • The parents of the listing person (PD).
  • Minors under 18 years of age who are in custody (MC).
  • Individuals of any age as Extra Affiliate (AA).

Chapter N ° 5. Identification Information of the Employer and Other Contributors or of the institutions in charge of the Institutional or Trade Collective Affiliation

This information uses the following:

  1. The employer in the event that the affiliate who performs the management is a dependent employee and the affiliation or the news report requires it.
  2. The institutions accredited to carry out the collective affiliation of independent employees or members of communities or religious groups, administrators or pension payers. Also cooperatives, and pre-cooperatives of associated work, the family compensation funds in the event that the contributor is not dependent and the affiliation or the news report requires it.
  3. The entities in charge of making the affiliation and communicating the news of the individuals who are under its protection, or employers. Likewise, entities that have the power to make the affiliation or report news.

The News Report

It must be done by the contributor or head of the family. The beneficiaries only have the duty to inform the news that is specifically allowed in the instructive of the Resolution 0974 of the year 2016.

Chapter N ° 6. Information for the News Report

In space 41, you have to link affiliates those who are going to use something new in the system. Register in number 42 the date only for news 9, 10, 11, 12 and 15.

Chapter No. 7. Declarations and Authorizations

It should be noted that the affiliate have to read every statement and every authorization. Select with an X which or which ones you agree with.

Chapter N ° 8. The Signatures

Said Form It must be signed by the contributor, head of the employer family, contributor or institution in charge of the collective, ex officio or institutional affiliation. Similarly, it must be signed by the beneficiary only in the event of the death report of the contributor or head of the family.

Chapter N ° 9. The Annexes

In this field you must choose with an X the spaces pertinent to the documentation attached, as needed by the management that is done.

  • Information to be Managed by the Territorial Entity: In space 70, you have to process the data of the commercial consultant or the advisor of the User Service line.

What is the Medimas Membership Form for?

This formulary serves to gather all the necessary data of the contributor, the employer, the members of the family group and the beneficiaries. This in order to proceed to enter the system of all the information, and then formalize the affiliation to Medimas.

What is Medimas?

Medimas Health Promotion Entity, is a Simplified Stock Company, which originated from an institutional restructuring project admitted by the National Superintendency of Health. This through Resolution 2426 of July 19, 2017.

This institution began operating on August 1, 2017. It operates in the Health insurance system in the Colombian territory, with the concession of the affiliates of Cafesalud Entidad Promotora de Salud, SA

Medimas benefits

Among the benefits of Medimas are the following:

  1. There is the opportunity that, through affiliation to the Subsidized Regime, there are activities that promote health and prevention of some pathologies. Of course, detecting these in time.
  2. Vaccine supply.
  3. Restoring health.
  4. Assistance in emergencies.
  5. Outpatient and home care.
  6. Comprehensive assistance in reference to pregnancy, childbirth and postpartum process.
  7. People affiliated with the Regime have the possibility of attending a general and specialty medical appointment. They also have access to high cost, get mental health treatment, receive necessary medications, etc.

What is the Medimas Membership Form?

The Medimas Affiliation Form, is an instrument used to gather all the information required by Medimas. This with the aim of incorporating into the system the people who are going to affiliate. In such a way that they can begin to enjoy the services and benefits that EPS offers.

Don’t wait any longer and be part of medimas through the Medimas Affiliation Form. Have everything you need to fill it on hand.

If you have any questions, remember that in the first point of this article there is a link where you can check the manual to correctly complete this Form. We hope you complete your procedure successfully.


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