Publications & forms

Publications & forms

Download one of our publications or member forms.

Publications

2019 Health Cover Brochure
Information correct as at April 2019

Just Ask!® Brochure
Information correct as at May 2019

Private patient in a public hospital?
Information Sheet

Information correct as at March 2019

 

Student Dependant
Registration Form

Information correct as at January 2019

Participating Private Hospitals List
Information correct as at June 2019

   
Your rights and responsibilities as a private patient
   

You will need a PDF reader to view these brochures. To install click here.

 

Forms

Australian Government Rebate Form April 2019 (Print PDF)
Download, complete and return the Australian Government Rebate Form to Latrobe Health Services.

Latrobe Accident Form (Print PDF)
Download, complete and return the Accident Form to Latrobe Health Services.

Latrobe Clearance Certificate Request Form
Download, complete and return the Clearance Certificate Request Form to Latrobe Health Services.

Latrobe Direct Debit 'Easy Pay' Authority Form
Download, complete and return the Direct Debit Authority Form to Latrobe Health Services.

Latrobe Membership Application Form
Download and complete the Membership Application Form to join Latrobe, change your membership or alter your level of cover.
Waiting periods, default and limited benefits, restricted benefits, limits, co-payment and excesses may apply. Please refer to the terms and conditions of waiting periods.

CLAIMING:
If you are claiming for medical services provided whilst you were in hospital, you will need to complete a Latrobe Member Claim Form and both the Medicare Claim Form (MS014) and Two-way Claim Form (MS001).
Please note: All 3 Forms must be completed.

We will forward your accounts and Medicare claim forms to Medicare on your behalf.
If you have already submitted your medical claims to Medicare you’ll only need to complete  a Latrobe Claim Form and forward this with your Medicare Statement of Benefits.

Latrobe Third Party Authority Form (Print PDF)
This authority will allow nominated persons to make claims, equiries and alterations to your membership on your behalf.

Latrobe Third Party Authority Form (Interactive PDF)
This authority will allow nominated persons to make claims, equiries and alterations to your membership on your behalf.

Latrobe Orthodontic Form (Print PDF)
Download, complete and return the Orthodontic Form to Latrobe Health Services.

Latrobe Orthodontic Form (Interactive PDF)
Download, complete and return the Orthodontic Form to Latrobe Health Services.

Smart 'n Easy Application Form
Have your claim benefits deposited straight into your account.


You will need a PDF reader to view these forms. To install click here.

Too much paperwork?

Log in to your online member account or register to use this service and make your own changes online. Alternatively, contact us for assistance.