Health Plan - Medical Claim Form

Health Plan

You can print a blank claim form and complete, or edit the claim form online.

Make sure you have Adobe Acrobat Reader downloaded (not Adobe Preview). Download Adobe Acrobat Reader

To edit the claim form online please

1. Open the 'editable online' pdf  using either Chrome or Internet Explorer internet browsers for optimal results.

2. SAVE it to your computer before you complete the form.

3. Complete the form and save again, then send the completed form to us (see details below).


Completed Claim Forms can be submitted to Police Health Plan:

By post: Claims submitted by post must include original invoices and receipts; photocopies are not acceptable.

Send to: Police Health Plan Ltd, PO Box 12344, Wellington 6144.

By email: Attach your completed claim form to an email, along with your invoices and receipts, which have been scanned as a JPG or PDF file. Please don't embed these in the email. 

The scanned JPG or PDF must be easily readable or processing your claim may be delayed. Please keep your original receipts so they can be produced if requested.


When emailing forms, documents or pictures:
Please use the attachment function to attach your jpeg, png or PDF to your email. Do not insert them into your email as this will delay processing.

Make sure that your Eftpos receipt doesn't cover up any important information on your invoice:

If you are emailing your claim form, you don't need to post it.