Forms & Policy Documents

Click on the link below to upgrade to Primary Care Extra.  Or if not already a member, fill out an Application form, or apply online.  To compare policies, click on the Policy Comparison Chart.  To make a claim, click on the link below and download a claim form.

Click here to view the Privacy Statement

 

Application Forms and Upgrade Form 

 Upgrade to Primary Care Extra Form (or to apply online now, click here)

 Primary Care Application Form (or to apply online now, click here)

Primary Care Extra Application Form (or to apply online now, click here)

 #care4U Application Form (or to apply online now, click here)

PSA Primary Care Application Form (or to apply online now, click here)

 PSA Primary Care Extra Application Form (or to apply online now, click here)

 PSA #care4U Application Form (or to apply online now, click here)

 Hospital Select Application Form - Fillable: (download to your computer, 'Save', complete and email to sales@unimed.co.nz)

 Hospital Select Application Form

 

Direct Debit Forms

     Direct Debit Form - Fillable: (download to your computer, 'Save', complete and email to sales@unimed.co.nz)

     Direct Debit Form

 

Claim Forms

     Claim Form - Fillable:   (download to your computer, 'Save', complete and email along with supporting documentation to claims@unimed.co.nz)

     Claim Form

     Bereavement Grant Claim Form - Fillable:  (download to your computer, 'Save', complete and email along with supporting documentation to claims@unimed.co.nz)

     Bereavement Grant Claim Form

 Hospital Select Prior Approval Form

 Hospital Select Confirmation of Surgery Form

 

Policy Documents, Comparison Chart and Orthodontic Guidelines

 Primary Care Policy Document

 Primary Care Extra Policy Document

 #care4U Policy Document

 Hospital Select Policy Document

     Policy Comparison Chart

     Orthodontic Guidelines

     HealthCarePlus/UniMed Conditions of Membership

 

 

 
 
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