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Claim a refund of your hospital excess

  • Complete the form below to claim a refund of your hospital excess payment. Claims can be lodged up to 2 years after the admission date. Claims for an excess refund should only be lodged after the hospital admission – regardless of when the excess was paid.

  • The excess refund will be paid by electronic funds transfer (EFT) to the following account. Please allow 14 days for processing of this claim.

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  • Declaration

    By submitting this form, I declare the above details to be true and correct and confirm that I was an employee of the employer named on this form at the time of the hospital admission. I request reimbursement of my hospital excess payment and will provide a copy of the Claims Statement issued to me by my health insurer upon request.

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