Health Plan - Making a Claim

There are two types of claims you can make - a medical claim for general medical expenses such as doctors visits and a surgical claim to cover the cost of surgery.

For members with Basic or Comprehensive cover who require a CT, MRI or PET scan, complete a CT/MRI/PET Scan form.

Details on the claims processes can be found on the 'How To' sections under the 'Making a Claim' menu item to the left.

Medical Claims

Find out how to make a medical claim, and use our Medical Claim form to claim back your general medical expenses.

Send your completed medical claim to:

Claim refunds cannot be paid when a Health Plan Policy is in arrears.

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 Prior Approval Request Form.

Use our step-by-step guide to help you with the surgical approval process, and submit your Surgical Prior Approval Request Form (along with an estimate of the costs involved and a letter of referral to:

In the event the proposed fees for the surgical procedure fall outside Usual Reasonable and Customary Charges (URC), then Police Health Plan Ltd reserves the right to refer the member to another provider. Police Health Plan Ltd also reserves the right to refer the member to a specialist surgeon for a second opinion.

Once surgery has been completed, surgical invoices need to be forwarded to Police Health Plan using your approval number as a reference.

Excess Option - If you 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 existed under the voluntary excess option will still incur the voluntary excess if any procedure on that condition is carried out.