Pet Healthcare Plan Claim Form PDF Details

A pet healthcare plan claim form is an important document to have when seeking reimbursement for veterinary services. The form can be used to seek reimbursement from your pet health insurance provider for the costs of treatment your pet has received. By completing the form correctly, you can ensure that you receive the maximum reimbursement possible for the costs of your pet's care. Make sure to include all relevant information on the form, including the date and type of service provided, as well as the amount you are requesting for reimbursement. Keep a copy of the form for your records, and submit it to your insurance company as soon as possible after receiving treatment for your pet.

Below is the details concerning the form you were seeking to fill in. It will tell you the amount of time you will require to complete pet healthcare plan claim form, exactly what fields you will have to fill in, etc.

Form NamePet Healthcare Plan Claim Form
Form Length2 pages
Fillable fields37
Avg. time to fill out7 min 58 sec
Other nameshealthy pets insurance claim form no download needed, mypethealthcareclaimforms for vet, pet healthcare claim form, healthy pets claim insuracnce claim form

Form Preview Example

Pet Healthcare Plan


Ph: 1.866.725.2747 Fax: 1.919.859.8193

For office use only







This claim form must be filled out completely, and you must attach your itemized invoice. Incomplete forms will be returned.

Owner & Pet Information - This section to be completed by the policyholder

Last Name: _______________________________ First Name: ___________________ Policy Number: ___________________

Street: ________________________________ City & State: ______________________, _____ Zip Code: ___________

Phone Number: ________________________ Email Address: _______________________________________________

Check here and update above if you have new contact information

Name of Pet: _______________________________________________________________________________________

Call Name: _________________________________________________________________________________________

Breed: _____________________________________________ Sex: _____________ Age: ______________

First Date of Injury, Illness or Condition: __________________________________

Please provide a brief description of illness/injury/condition:




POLICYHOLDER DECLARATION: I confirm that all details provided herein are true and accurate. I understand that I am financially responsible to the Veterinarian for the entire treatment. I also understand that the deliberate misrepresentation of the animal’s condition or

the omission of any material facts may result in the denial of the claim and/or the cancellation of coverage. I authorize the insuring company and its authorized representatives to review and obtain a copy of all records including the insurance claim records and medical records as to the examination, history, treatment and prognosis with respect to any condition. I understand that all charges from my

Veterinarian may not be covered or may exceed my plan benefits.




Policyholder Signature (REQUIRED)




SECTION -2- Please have your Veterinarian provide information pertaining to the invoices submitted with this claim.


Date of Treatment















Length of time pet has been registered at your practice? ___________Has the pet been treated for a related problem? Yes/No

If yes, please provide detailed information of the treatment or any related conditions:




Name and phone number of previous or referring Veterinarian: ____________________________________________________________

VETERINARIAN DECLARATION: I certify that to the best of my knowledge all the information contained on this form is correct. I also understand it is a criminal act to assist in the preparation or presentation of a false or fraudulent claim under an insurance policy.





Print Name





Get it, File it, Send it!!


Download a claim form from

Call Customer Service at 1.866.725.2747

E-Mail us at and request a claim form


Filing a claim under the Pet Healthcare Plan is simple and straightforward.

Complete Section 1 of the claim form, and have your Veterinarian complete Section 2 (remember, incomplete forms will be returned without processing).

Include your itemized invoice for all services.

Submit your claim for reimbursement.

Once your claim is completed you will receive a claims explanation of benefits explaining how your claim was processed.

**Remember to file your claim form and itemized receipts within the required timely filing limit.






































































































919-859-8193Pet Healthcare P.O. Box 37940

Raleigh, NC 27627-7940

Fraud Warning:

Any person who knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and may subject such person to criminal and civil penalties.

How to Edit Pet Healthcare Plan Claim Form Online for Free

The entire process of filling out the healthy pets claim insuracnce claim form is fairly uncomplicated. Our team made sure our tool is not difficult to understand and helps prepare any kind of form very quickly. The following are some of the simple steps you need to take:

Step 1: The initial step will be to choose the orange "Get Form Now" button.

Step 2: As soon as you have accessed your healthy pets claim insuracnce claim form edit page, you will notice all actions you may undertake concerning your file in the upper menu.

Provide the required information in each segment to fill in the PDF healthy pets claim in, sura, cn, ce claim form

completing pet healthcare plan claim form part 1

Type in the demanded data in the area Date, Date, of, Treatment, Treatment Diagnosis, and Signature.

Completing pet healthcare plan claim form step 2

You'll be asked to type in the details to let the software fill out the box HOW, TO, FILE, YOUR, CLAIM will, be, returned, without, processing processed, FAX, MAIL, and ELECTRONIC.

pet healthcare plan claim form HOWTOFILEYOURCLAIM, willbereturnedwithoutprocessing, processed, FAX, MAIL, and ELECTRONIC fields to fill out

Step 3: When you have hit the Done button, your form will be accessible for export to each device or email address you indicate.

Step 4: Be certain to keep away from possible future worries by making at least a pair of duplicates of the document.

Watch Pet Healthcare Plan Claim Form Video Instruction

If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .