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Download a Claim Form

Members Home> My Account Download a Claim Form> Go Paperless> Accepted Qualifications> Downloadable Forms> Member Contact Form> 2014 Membership Plans Benefit Tables 2014 Connect Health Cash Plan> 2013 Membership Plans Increase Your Level of Cover> Member Links> Treating Customers Fairly Members FAQ> Feedback Form> Complaints Handling Procedure> Memorandum And Rules> Fraud>

The following Claim Forms are provided for your use:

Benefit Claim Form

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When you click on the file below, a new window should open on your PC containing the form.

Online Benefit Receipt Claim Form

Online Hospital Receipt Claim Form

Please note that the Online Benefit Claim Form can be used to save your details for the next time you wish to make a claim. (These details will only be stored on your own PC). Please complete, print, sign and send the claim form to Health Shield, with accompanying receipts where required.

 

Get AcrobatTo view pdf files will need to have Acrobat Reader installed on your computer - most computers have Acrobat installed but if you have problems opening the files you can download Acrobat Reader from Adobe by clicking on the Adobe icon below. If you do not have internet access to download or install Acrobat Reader, and you require this, contact your systems administrator.