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

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

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Hospital Claims

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Types of Claim Forms