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General enquiries:

(04) 496 6800


0800 500 122

Surgery Approval Request Process

How to apply for prior approval for surgery

1. Book a date for your surgery and submit the estimated costs involved along with your letter of referral.

2. Complete your Surgical Approval Request form at least 10 days before your date of surgery.

  • Accident related injuries requiring surgery - If you have had an accident related injury and require surgery, you will need to contact ACC for cover because Health Plan does not cover acute or accident related injuries.  If, however,  you denied cover by ACC, complete a Surgical Approval form and attach the letter of declination from ACC.
  • Surgery with a GP - If you require surgery with a GP you do not need prior approval for that surgery.  You can pay for the procedure and claim back up to $1000 per visit. If this is what you require, please refer to the Medical Claims page.


To edit the surgical approval request form online please:

  1. Open the 'editable online' pdf using either Chrome or Internet Explorer internet browsers for best results.
  2. SAVE it to your computer before you complete the form so you don’t lose your details.
  3. Complete the form, save again, then send the completed form to us (see details below).

Attach the original letter of referral and estimate of costs, and send to: Police Health Plan Ltd, PO Box 12344, Wellington 6144.



Email your letter of referral and estimates of costs as attachments (jpeg, png or PDF) to [email protected] . If you are emailing your form, you don't need to post another copy of it.

Please note when scanning your forms, letters and estimates of costs, ensure the documents do not obscure any important information on your other documents.


The process 

If approved, you will then receive a surgical approval letter which includes your approval number, and you take this with you to the hospital. Use the approval number on your hospital admission forms.

Forward any invoices in relation to your surgery to Health Plan, with your member number and approval number as reference.


Paying your cover’s excess

If your cover has a surgical excess, you will be advised by letter on how to pay this once Health Plan has received, and paid, the surgical invoices directly to the provider.

Please do not pay the provider directly until you have been advised by Health Plan on where to pay your surgical excess.


Claiming for appointments pre and post surgery

If you have any costs relating to the surgery, including specialist consultations and scans, these can be claimed in addition to your surgical claim for up to four months following the date of surgery.

To be reimbursed for these, complete a medical claim form via our Health Plan Portal and attach the receipts. Please remember to note your surgical approval number on the claim form.

If you need any help, please contact or call the Member Services Centre on 0800 500 122.