Forms

These  forms (when completed) are used to support requests for additional funding consideration and assist various AHSA maintenance processes..

  • Non Prostheses List Payment Request

    This form is to be used to request funding consideration for a medical device not listed on the Ministerially Approved Prostheses List.
  • High Cost Drug Request

    This form is to be used when requesting payment for a very high cost drug which are not covered under other funding arrangements.
  • Insulin Pump / Replacement

    This form provides confirmation of details relating to a Health Fund member applying for a replacement or upgrade of an Insulin Pump.
  • Hospital Claim

    The National Private Patient Hospital Claim form is the hospital claim form to be used for the payment of fund benefits for privately insured patients in private and / or public hospitals within Australia.
  • EFT Banking

    This is the hospital EFT banking form to allow AHSA member funds to directly deposit money into a hospital’s nominated bank account.
  • Cochlear Sound Processor Replacement / Upgrade

    This form is used to ensure that all required information is provided to a health fund to enable a responsible funding decision to be made.
  • Bone Conduction Sound Processor Replacement / Upgrade

    This form is used to ensure that all required information is provided to a health fund to enable a responsible funding decision to be made.