Health Plan - Claims
Members can claim at any time when receipts total $100 or more. All claims must be submitted for settlement within 18 months of incurring the charge. Any claims received that are over 18 months old, will not be reimbursed by Police Health Plan.
Administration Fee
Each total claim submitted under all plans, attracts a $20 administration fee.
Surgical Claims
All surgical claims costs must be pre-approved by Police Health Plan Limited, prior to surgery. Once surgery has been decided necessary, pre-approval should be arranged by completing a Surgical Pre-approval Form.
Applications for prior approval of surgery must be received at least 7 working days prior to surgery. For urgent cases or to have a form posted contact our Member Services Team.
In the event the proposed fees for the surgical procedure fall outside Usual Reasonable and Customary Charges (URC), then Police Health Plan Limited reserves the right to refer the member to another provider. Police Health Plan Limited also reserves the right to refer the member to a specialist surgeon for a second opinion.
Once surgery has been completed, surgery costs should be claimed by completing a Surgical Claim Form.
Excess Option - If I choose to switch from a voluntary excess to the no-excess option, a 90-day stand-down period will apply before cover with no-excess commences. All conditions that were existing under the voluntary excess option will still incur the voluntary excess if any procedure on this condition is carried out.
Medical Claims (non-surgical)
You must keep small claims until they total $100 and these must be submitted within 18 months of incurring the charge. When claiming please supply original invoices or receipts. Photocopies are not acceptable.
All details must be entered on the Health Plan Medical Claim Form. If you cannot print one from our website please contact Member Services Team, to have one posted to you. Claim forms are also supplied with your claim settlement.
Cosmetic Treatment
Means any diagnosis, treatment, surgery, or any other procedure undertaken to improve, alter or enhance appearance, for any reason.
Claim Refunds
Claims should be sent to: Police Health Plan Limited, PO Box 12344, Wellington.
All claims will be settled to the premium contributor, unless the contributor has specified otherwise. Claim refunds will be paid to either the contributor’s nominated bank account or if not specified, to their Police and Families Credit Union Savings account.
Claim refunds cannot be paid when a Health Plan Policy is in arrears.
