Nib Claim Form PDF Details

Filing a claim with NIB encompasses several detailed steps meant to ensure both accuracy and compliance with the policy requirements. Firstly, individuals are prompted to provide comprehensive personal and policy details, including their customer number and contact information, ensuring the process is customized and secure. Following this, the claim details section requests information specific to the service being claimed—whether it's an everyday extra like dental or optical services, or medical services received in a hospital setting, highlighting the form's adaptability to different health service claims. This portion delicately handles the inclusion of sensitive information, such as whether the claim is related to compensation or the result of an accident, showing respect for the claimant's circumstances. The form also offers multiple reimbursement options, adding a layer of convenience for the claimant in how they receive their benefits. An imperative component of the process involves the claimant’s consent and declaration, ensuring all information provided is accurate and true, and authorizing NIB to proceed with claim assessment. This step reinforces the mutual trust between the claimant and the insurer. Finally, NIB emphasizes the need for thorough documentation, such as attaching original, itemized receipts in English, and specifies the eligibility criteria for claims, including the timeframe for service receipt and provider recognition. The form rounds off with clear instructions on how to submit the claim, either by mail or in person, and offers support through customer care services, showcasing NIB's commitment to assisting their clients every step of the way.

QuestionAnswer
Form NameNib Claim Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnib nz claim form, nib application, nib online form, nib blank forms

Form Preview Example

CLAIM FORM

STEP

1

Complete your policy details

Your customer number

Your family name ___________________________________ Your first name _____________________________

Your current postal address (this is the address nib will send any correspondence to do with this claim)

________________________________________________________________________________________________

____________________________________________ Daytime phone number (____________________________)

STEP

2

Complete the details of your claim

I am claiming everyday Extras (e.g. dental, optical, physio)

Date

Type of service

Name of the provider

Is this related to

Is the account

compensation?

paid in full?

 

 

 

 

 

 

 

 

 

 

 

Yes * No *

Yes * No *

 

 

 

 

 

 

 

 

Yes * No *

Yes * No *

 

 

 

 

 

 

 

 

Yes * No *

Yes * No *

 

 

 

 

 

I am claiming medical services received in a hospital (e.g. doctors & specialists fees)

Date of

Date of

Name of the hospital

Is this related to

Is this the result of

admission

discharge

compensation?

an accident?

 

 

 

 

 

 

 

 

 

 

Yes * No *

Yes *

No *

 

 

 

 

 

 

 

 

 

Yes * No *

Yes *

No *

 

 

 

 

 

 

STEP

3

How do you want nib to pay your claim?

please send me a cheque made out in my name

please send me a cheque made out in my partner’s name (only available if you have authorised nib to do this)

please credit my SafeClaim account (if you have authorised nib to credit your account using a Direct Credit Authority Form)

I authorise nib to pay cash to ______________________________________________________________

If you have not yet paid the account, nib will send you a cheque to forward to your provider. You will need to pay the rest of your bill.

STEP

4

Read the following important information and sign this form

By signing this form, I declare that all information I have provided to nib, including all information in this form, is true & correct. I authorise nib to use this information and any other information I have previously given nib to assess and process my claim(s). I consent to nib contacting my previous health fund and/or service provider to request information and/or personal and medical records to verify any aspect of the claim(s). I acknowledge and provide consent for nib to use this information for other purposes related to this claim as outlined in the nib Privacy Policy.

I confirm these services have not been claimed as Point of Service such as iSOFT or HICAPS and that this claim is not subject to workers compensation, damages action, third party insurance or any other source.

I confirm that the services I am claiming were performed by the providers, and received by the persons as indicated on the healthcare provider’s receipts.

Your signature

(or your authorised partner)

Date

/ /

nib0072_RCF_1211

My claims checklist

*I have attached all the receipts and/or accounts for each item I am claiming.

*All the receipts/accounts I have attached are original, itemised in full, written in English, and are on the provider’s official stationery or have the provider’s official stamp.

*I received the services within the last two years.

(nib does not pay claims made two years or more after the services were received)

*I am claiming services from an nib recognised provider.

(nib does not pay claims for the services of providers who are not recognised by nib)

*I have claimed with Medicare for medical services I had in hospital and I have attached the top portion of the Medicare Statement of Benefits and my receipts.

*I have indicated where applicable that the claim is related to worker’s compensation.

nib Claims Processing

Reply Paid 62208 Locked Bag 2010 Newcastle NSW 2300

You can mail your

claims to this address

(no stamp required)

or take your claim to an

nib Retail Centre.

Need help completing

this form?

 

Call the nib Customer

Care Centre on

 

.AU

 

 

13 14 63 or visit NIB.COM

nib health funds limited abn 83 000 124 381

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Concentrate when completing this form. Make sure that all required blanks are done accurately.

1. For starters, while filling in the nib claim, start out with the part that includes the next fields:

nib claim form nz completion process explained (step 1)

2. Once the previous section is filled out, proceed to enter the suitable details in all these: please send me a cheque made out, please send me a cheque made out, please credit my direct credit, If you have not yet paid the, STEP Read the following important, By signing this form I declare, Your signature or your authorised, Date, and nibRCF.

Stage no. 2 in filling out nib claim form nz

3. Completing MY CLAIMS CHECKLIST I have, and are on the providers oicial, I received the services within, nib does not pay claims made two, I am claiming services from an, nib does not pay claims for the, I have claimed with Medicare for, top portion of the Medicare, I have indicated where applicable, QUICK CLAIM, and Its as easy as taking a photo of is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

How you can complete nib claim form nz portion 3

Regarding Its as easy as taking a photo of and I have claimed with Medicare for, make sure that you take a second look here. Both these are the most important fields in this PDF.

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