Types of Claim Forms
Hospital Claims

We have direct payment agreements with all of our listed hospitals so we can settle the bill directly with the hospital for all eligible costs, covered by your plan.

Before going into hospital, you should check what cover your policy provides for a particular hospital or treatment centre by calling our customer service team on 01 562 5100.

You will need to know the following information before you call us:

• Consultant name
• Hospital Name
• Procedure Code

Hospital Claim Forms

Hospitals will supply the below forms to Irish Life Health members:

• Hospital claim form
• Out-patient scans claim form
• Psychiatric claim form
• Post natal home help form
• PET-CT Pre Authorisation form
• Private Ambulance patient transfer form
• ICU Claim Form
• Anaesthetists’ Claim Form
• Maternity claim form
• Minor Injury Clinic form
• Health in The Home Referral Form
• Knee Arthroscopy Claim Form
• Back Up Physiotherapy Claim Form
• Exogen Therapy Claim Form

Pre Approval Forms

Before you fill out these forms, you will be required to get pre-approval in advance

• Pre-authorisation form for Gender Affirmation Procedures
• Overseas pre-approval claim form
• Pre-authorisation for Exogen Therapy
• Procedure Drug Facility Proposal Form
• Pre-authorisation for Negative Pressure Wound Therapy