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Navigating the Pet Plan Claim form can feel daunting, but understanding its components is crucial for a smooth claims process. Designed to assist in claiming for veterinary fees, the form requires you to provide detailed information about your pet, including their name, policy number, and contact information. It’s essential to clearly identify whether you are submitting a claim for a new condition or a continuation of an existing one. Be mindful that all relevant sections marked in yellow need your attention, as incomplete or unclear claims can lead to frustrating delays. The form also requires a comprehensive clinical history if this is the first claim for your pet, highlighting the significance of good documentation from your veterinarian. Additionally, it asks for details of the illness or injury, payment preferences, and confirms important aspects like any other insurance coverage your pet may have. With careful attention to detail and completeness, you can help ensure that your claim is processed quickly and efficiently, allowing you to focus more on your pet’s health and well-being.

Pet Plan Claim Example

For Petplan use only
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0800 255 426

the pet insurance people

Claim Form for Veterinary Fees

Are you completing this form for a: New illness or injury Continuation illness or injury

Complete ALL sections clearly and in full. Complete sections shaded yellow only.

Please complete the claim form fully, using a black pen and block capitals. Missing information will delay your claim.

Please use a separate claim form for each pet, each illness or injury and each treating veterinary practice.

1. Policyholder to complete

POLICY NUMBER

2. Policyholder to complete

ABOUT YOU

Policyholder’s

 

surname

 

First name

Contact no.

Email address

3. Policyholder to complete

ABOUT YOUR PET

Pet’s name

Pedigree name

(If applicable)

If this is the first claim you are submitting for your pet you must include a full clinical history from all of the vets that your pet has been registered with, plus any information you may have from the person/party you obtained your pet from. Your claim will be delayed if this is not included.

4. Policyholder to complete

DETAILS OF YOUR PET’S ILLNESS

What condition(s) are you claiming for?

Please tell us the date you first noticed any signs that your pet was unwell or injured before booking an appointment with your vet. Your claim will be delayed if we do not have this information.

 

Date and time Condition first noticed

 

 

 

AM

/ PM

 

 

 

 

 

 

 

 

Date and time pet seen by vet

 

 

 

AM

/ PM

 

 

 

 

 

 

 

Did the illness or injury result in the death of your pet?

Yes

 

No

 

 

 

 

 

Date of death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Policyholder to complete

PAYEE DETAILS

 

 

 

 

 

Payments will be automatically made payable to the policyholder(s) named on your Certificate of Insurance, unless we are instructed otherwise.

Is any insured registered for GST?

Yes

No

PLEASE COMPLETE ONE OF THE FOLLOWING

Please note we will not pay your vet unless it has been previously agreed with them to do so. Please check with your vet.

A. Pay Vet - please tick

I/We have arranged with my/our vet and would like this claim paid directly to them, less my excess and any other non-claimable items.

Name of the vet practice

Customer ID

Account Name

Account Number

Vet practice sign here

Date:

 

B. Pay Policyholder(s) - please tick

I/We wish the claim to be paid to the policyholder(s) name on the Certificate of Insurance.

Name

Account Name

Account Number

IMPORTANT NOTES

Please send completed claim forms including all receipts to

Petplan Australasia Pty Ltd, PO Box 112250, Penrose Auckland 1642

Petplan Australasia 2097390 administers the policy on behalf of Allianz Australia Insurance Limited ABN 15 000 122 850 (Incorporated in Australia) trading as Allianz New Zealand which underwrites the policy.

Policyholder’s address

Postcode

Please tick here if this is different to the address on your Certificate of Insurance. Your policy records will be updated with these details.

Dog

 

Cat

 

 

Pet’s date of birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Breed

 

 

 

 

Male

 

 

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is this pet insured with any other company?

Yes

 

No

 

 

If Yes, please state which company

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Have you, or are you intending to lodge a claim for this

Yes

 

No

 

 

 

 

 

illness/injury with them?

 

 

 

 

 

 

 

 

 

 

 

Please tell us the names and addresses of all the vet practices where the pet has been treated before or the vet that referred you. Please use a separate sheet of paper for more than one.

Practice Name

Address

Postcode

Phone

Date: from

to

 

If your pet was injured, please provide details of how the injury occurred, on a separate sheet of paper. If anyone else is responsible for the injury, please provide their name and address.

Not covered by your policy - Routine and preventative healthcare eg. shampoo, nail clipping, teeth cleaning, worming, desexing and vaccination, any illness within your waiting period and pre-existing conditions.

INCOMPLETE CLAIM FORMS WILL BE RETURNED TO THE POLICYHOLDER(S)

In order for your claim form to be processed in a timely manner please make sure that you have completed the claim form in full, have your vet complete their section, and it is signed by both You and Your Vet, and includes itemised invoices.

Please complete the checklist, read the Privacy statement and sign the form below.

Are all the sections of the claim form completed?

Has the Vet completed all their sections of the claim?

Have you included all itemised invoices with your claim?

Have you and the vet signed the claim form?

Privacy: The Privacy Act 1993 requires us to tell you that as an insurer we collect your personal and sensitive information in order to calculate your loss and entitlement, determine our liability, compile data and handle claims. When handling claims, we may disclose your personal and other information to third parties such as other insurers, loss adjusters, external claims data collectors, investigators and agents, to the Insurance Reference Service (IRS), etc., or other parties as required by law.

You have the right to seek access to your personal information and to collect it at any time. Please contact us on 0800 255 426 8:30am-5pm Mon-Fri and advise us of the changes.

IDR Statement: Disputes are not an everyday occurrence at Petplan. However we do provide an internal dispute resolution process should any dispute arise. Please feel free to ask for details. If you are not satisfied with the outcome of this process, we will advise you how to contact the insurance industry’s external independent complaints scheme (subject to eligibility).

I/We certify the information given on this form is truthful, accurate and complete. No information likely to affect this claim has been withheld. I/We understand that this claim may be refused

if information is untrue, inaccurate or concealed. I/We acknowledge that I/we have read and understood the Privacy Act 1993 and consent to the collection, storage, use and disclosure of personal and sensitive information to all persons affected by this claim. I/We acknowledge that if I/we do not agree to the collection of this personal and sensitive information then Petplan will be unable to process my/our claim.

I confirm that I have checked the information on this claim form and that it is all correct to the best of my knowledge and belief.

Please sign here

Date:

 

 

New illness or injury - Complete ALL sections clearly and in full.

Continuation illness or injury - Complete sections shaded yellow only.

IF THIS IS THE FIRST CLAIM FOR THIS PET, PLEASE SUBMIT A FULL CLINICAL HISTORY

ASK YOUR VET TO COMPLETE THESE THREE SECTIONS

6. Vet practice to complete

GENERAL INFORMATION

When was this pet first registered at your practice?

If this pet has been referred please give the name, address and telephone number of the practice which referred it.

Name

Address

Telephone number

In connection with the treatment claimed, did you make a house visit

Yes

 

No

 

 

 

or provide out of hours treatment?

 

 

 

 

 

 

If Yes, why?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is any part of this claim for a condition the pet can be

 

 

Yes

 

No

 

vaccinated against?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Yes, were the pet’s vaccinations up to date at the time of treatment?

 

 

 

 

 

Yes

 

Please give date

No

 

 

 

Don’t Know

 

 

of last vaccination

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is any part of this claim for dental treatment?

 

 

Yes

 

No

 

 

 

If Yes, please enclose a full clinical history over the last 2 years. Not providing this will delay the client’s claim.

Is any part of this claim for treatment of a urinary problem?

Yes

 

No

If Yes, is the cost of diet food included in this claim?

Yes

 

No

 

 

If Yes, please provide the name of the diet food being used and total cost being claimed.

Name

 

 

Amount

$

 

 

 

 

 

 

 

 

In case of a urinary problem, were crystals present?

 

Yes

 

No

 

 

 

 

If Yes, are the crystals:

Oxalate

 

Struvite

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If other, please specify

Please give dates and results of last 2 urine tests

Date:Result

Date:Result

7. Vet practice to complete

ABOUT THE ILLNESS OR INJURY

Condition

Name of the illness or injury

(if no diagnosis has been made, please give clinical signs)

Did death or euthanasia result from this illness or injury?

Yes

 

No

 

Date of death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If the pet was put to sleep, did you recommend this?

 

Yes

 

No

 

Is this claim a continuation of a previous claim?

 

Yes

 

No

 

 

 

 

 

 

 

Treatment date: from

to

 

 

 

 

 

 

 

 

 

 

 

 

 

When did this illness or injury begin or show clinical signs?

(as started by the client and noted in your records)

To your knowledge, has this pet been seen before for:

 

 

 

This illness or injury

Yes

 

No

 

Any similar or related illness or injury

Yes

 

No

 

 

Any similar or related clinical signs

Yes

 

No

 

 

 

 

 

 

If Yes, please provide the history with dates

Date:

Date:

Total amount being claimed (inc. GST)

$

PLEASE ENCLOSE FULL ITEMISED INVOICES AND RECEIPTS TO SUPPORT THIS CLAIM

8. Vet practice to complete

DECLARATION BY VETERINARY PRACTICE

This practice is authorised to have the claim(s) paid direct

Yes

 

No

 

 

 

 

 

 

 

 

 

I have checked the information on this claim form and confirm that it is all correct to the best of my knowledge and belief.

Name

Position in practice

Phone

Fax

Email

Vet practice stamp here

Signature

Date:

(Vet practice manager)

PLEASE USE A SEPARATE CLAIM FORM FOR EACH PET, EACH ILLNESS OR INJURY AND EACH TREATING VETERINARY PRACTICE PLEASE SEND COMPLETED FORMS INCLUDING ALL RECEIPTS TO:

PETPLAN AUSTRALASIA PTY LTD, PO BOX 112250, PENROSE AUCKLAND 1642

Once we have received and lodged your claim, an acknowledgement will be sent to the contact details that we have on record. If you do not receive the acknowledgment, feel free to call our customer care centre at 0800 255 426 to update your details on Petplan’s records and to confirm that your claim has been received and lodged.

If this is your first claim, we will request a complete medical history for your pet. To fast track the history requesting process you may attach the complete medical history to your claim and provide us with the date you took on ownership of your pet and all vets attended whilst in your care.

If you need an update on the status of your claim during the time that it is being processed, you can email us on

info

@

petplan.net.nz

All claims are processed in order of receiving them and we will deal with your claim as quickly as possible.

Form Characteristics

Fact Name Fact Description
Contact Information If you have questions while filling out the Pet Plan Claim form, reach out to Petplan at 0800 255 426 for assistance.
Required Documentation When submitting your claim, include a complete clinical history from all veterinary practices your pet has visited, especially if this is the first claim.
Payment Instructions Ensure you clearly specify whether the claim payment should go directly to the veterinarian or to you, the policyholder, to avoid processing delays.
Incomplete Submissions Be aware that incomplete claim forms will be returned. Take the time to ensure all sections are completed accurately to prevent delays.

Guidelines on Utilizing Pet Plan Claim

Filling out the Pet Plan Claim form can initially seem daunting. However, breaking it down into clear steps can simplify the process. By ensuring accuracy and completeness, you can help facilitate a quicker processing of your claim.

  1. Start by noting your policy number at the very top of the form.
  2. Provide your details under the "ABOUT YOU" section. Fill in your surname, first name, contact number, and email address.
  3. Detail information about your pet in the "ABOUT YOUR PET" section. Include the pet's name and pedigree name (if applicable). If this is your pet's first claim, remember to attach a full clinical history from all veterinarians your pet has visited.
  4. Describe your pet’s illness in the "DETAILS OF YOUR PET’S ILLNESS" section. State what condition you are claiming for and when you first noticed signs of illness or injury. Include the date and time of your pet's vet visit, and note if the illness led to your pet's death.
  5. Complete the PAYEE DETAILS. Decide how you want the payment processed—either directly to your vet or to yourself—and fill in the appropriate information.
  6. Fill out your pet's details, including breed, date of birth, and if the pet has insurance with another company. Be sure to record any related vet practices where your pet has been treated.
  7. Check for any additional notes such as how an injury occurred, if applicable. Provide any details as needed.
  8. Ensure all sections are completed. Review that both you and your vet have signed the necessary sections and that all invoices and supporting documents are included.
  9. Mail the claim form along with all receipts to Petplan Australasia Pty Ltd at the address specified on the form.

After mailing your completed claim form, keep an eye out for an acknowledgment. This confirmation will typically be sent to the contact details you provided. If you don't receive the acknowledgment within a reasonable time, reaching out to the customer care center is encouraged to ensure your claim was received.

What You Should Know About This Form

What should I do to complete the Pet Plan Claim form?

Complete all sections of the form clearly and fully. Use a black pen and block capitals. Pay special attention to the sections shaded yellow if your claim is for a continuation of an illness or injury. Make sure to provide a separate claim form for each pet, each illness or injury, and each treating veterinary practice.

Why is a full clinical history required for my first claim?

If this is the first claim you're submitting for your pet, you must include a full clinical history from all the veterinary practices your pet has been registered with. This information helps us assess your claim accurately. Missing the clinical history will delay the processing of your claim.

What details do I need to provide about my pet's illness?

You need to provide the condition(s) you are claiming for and the date you first noticed any signs of illness or injury. Include the date and time your pet was seen by the vet. Failure to include this information will delay your claim.

How can I choose to have the claim payment made?

You can choose to have the payment made either directly to your vet or to yourself as the policyholder. If you wish for the payment to go directly to your vet, ensure you have arranged this with them beforehand and complete the necessary sections on the claim form.

What happens if the claim form is incomplete?

Incomplete claim forms will be returned to you. To prevent delays, ensure all sections are completed, the vet has filled in their part, and both you and your vet have signed the form. Include all itemized invoices as well.

What is the importance of the Privacy statement?

The Privacy statement informs you about how your personal and sensitive information might be used and disclosed. This includes sharing with third parties as necessary for handling claims. Your consent is needed to process your claim, and without it, Petplan will be unable to proceed.

Why is it necessary to specify if my pet has other insurance?

You must disclose if your pet is insured with another company or if you plan to lodge a claim for the same illness or injury with them. This information is crucial for us to determine how to proceed with your claim fairly and accurately.

What should I do if I don’t receive an acknowledgment for my claim?

If you do not receive an acknowledgment after submitting your claim, contact our customer care center at 0800 255 426. They can update your details in our records and confirm whether your claim has been received and lodged.

What is included in the definition of routine and preventative healthcare?

Routine and preventative healthcare includes treatments like shampooing, nail clipping, teeth cleaning, worming, desexing, and vaccinations. Claims related to these services are not covered by your policy.

How can I get an update on my claim status?

During the processing time of your claim, you can email us at info@petplan.net.nz for updates. We process claims in the order they are received, and we aim to resolve your claim as quickly as possible.

Common mistakes

When filling out the Pet Plan Claim form, people often make mistakes that can lead to delays in the processing of their claims. A common error is neglecting to complete all sections of the form fully. Each section contains important information required for the assessment of the claim. If any part of the form is left blank or filled out incorrectly, it can result in a halt in processing until the necessary information is provided.

Another frequent mistake is not submitting the required clinical history for the pet. For first-time claims, it is essential to include a full clinical history from all veterinary practices where the pet has been registered. Failing to provide this information will delay the claim significantly. Claimants should ensure they gather this documentation before submitting their claims.

People also overlook the requirement to use a black pen and block capitals. This formatting guideline is crucial. If the form is completed using other colors or confusing handwriting, it may be difficult for the claims team to read the information. Improving the clarity of the form enhances efficiency and reduces the chances of misunderstandings.

Finally, many claimants forget to check that the form has been signed by both themselves and their veterinary practice. Both signatures are necessary for the claim to be considered valid. If either signature is missing, the form will be returned, further extending the time it takes to process the claim. By carefully reviewing these requirements, individuals can help ensure that their claims proceed smoothly and without unnecessary delays.

Documents used along the form

When submitting a Pet Plan Claim form, certain additional documents may be necessary to facilitate the claims process. Below is a list of commonly required documents, along with a brief description of each.

  • Veterinary Invoice: This document includes detailed charges from the veterinary practice. It should list each service provided, the date of the service, and the total amount charged.
  • Clinical History: If this is the first claim for your pet, you must provide a full clinical history from all previous veterinary practices. This information helps verify prior treatments and conditions.
  • Claim-specific Notes: If the pet's condition arose from an injury, policyholders should provide additional details on how the injury occurred. This will clarify the context of the claim.
  • Additional Claim Forms: Separate claim forms are often needed for multiple pets or distinct injuries. Ensure that you fill out a different form for each relevant circumstance.
  • Consent Forms: If the claim involves a third party or if the pet’s owners are different from the policyholders, consent forms might be required to allow disclosure of information.
  • Direct Payment Agreement: If requesting that payment be made directly to the veterinary practice, a signed agreement stating this preference must be submitted along with the claim form.

Providing these documents along with the Pet Plan Claim form can significantly expedite the claims process. It is essential to ensure that all paperwork is complete and accurate to avoid delays in receiving benefits.

Similar forms

  • Health Insurance Claim Form: This document is similar because it requires detailed information about the patient (pet) and the nature of the health issue, including dates and treatments. Both forms ask for verification of the policyholder's details and completion by a medical professional.
  • Auto Insurance Claim Form: Like the Pet Plan Claim Form, this form demands specific information about the incident that caused damage (injury or illness). It also includes sections that ensure the details are thoroughly completed to avoid delays in processing.
  • Homeowners Insurance Claim Form: This document shares similarities in the need for itemized receipts and detailed descriptions of the claimed event. It requires the policyholder's information and acknowledgments similar to those in the Pet Plan Claim Form.
  • Employee Benefits Claim Form: Just as in the Pet Plan Claim Form, the employee benefits form requires consistent reporting of incidents that affect claims, along with signed confirmations from the responsible parties.
  • Workers' Compensation Claim Form: Both forms necessitate comprehensive details of the situation leading to the claim. They involve describing the nature of the injury or incident in a structured format and require signatures from both the claimant and relevant professionals.
  • Travel Insurance Claim Form: Like the Pet Plan Claim Form, this document focuses on claims for specific incidents occurring within a defined timeframe and needs comprehensive details to process claims accurately.
  • Disability Claim Form: This document emphasizes a thorough description of the injury or illness, similar to the Pet Plan Claim Form. It also requires validation from medical professionals and includes a declaration of the information's accuracy.

Dos and Don'ts

When filling out the Pet Plan Claim form, it is important to follow specific guidelines to ensure your claim is processed smoothly. Below are seven essential things you should do and avoid while completing the form.

  • Do complete all sections of the form clearly and in full. Incomplete forms will result in delays.
  • Do use a black pen and block capitals to fill in the claim form.
  • Do provide thorough details about your pet’s illness or injury, including the date you first noticed symptoms.
  • Do include itemized invoices and receipts to support your claim; make sure they are attached before submitting.
  • Do check with your vet regarding the payment method before indicating it on the form.
  • Don’t submit one claim form for multiple pets, illnesses, or veterinary practices. Use separate forms for each.
  • Don’t omit any necessary medical history or details about previous treatments that could impact your claim.

Following these guidelines can help expedite the claim process, giving you peace of mind when dealing with your pet’s health issues.

Misconceptions

When dealing with the Pet Plan Claim form, several misconceptions can arise. Understanding these can help ensure a smoother claim process for pet owners.

  • Misconception 1: All sections of the form are optional.
    In fact, it is crucial to complete ALL sections clearly and in full. Missing information could delay your claim, so it’s important to provide complete details.
  • Misconception 2: You can use one form for multiple pets.
    Each pet requires a separate claim form. Additionally, if your pet has multiple illnesses or injuries, each condition needs its own form, as does each treating veterinary practice.
  • Misconception 3: You don’t need to provide your pet's medical history for your first claim.
    If this is your first claim for your pet, you must include a full clinical history from all vet practices your pet has visited. Not providing this information will likely result in a delay.
  • Misconception 4: You can have your vet paid without prior agreement.
    You must check with your vet and arrange for payment to be made directly to them in advance. The claim will not be paid to your vet unless this has been established.

Being aware of these misconceptions can simplify the process and enhance the chances of a successful claim. Always double-check the requirements before submitting your form.

Key takeaways

1. Complete the form in full: Ensure that all sections are filled out clearly and completely, as missing information can lead to delays in processing your claim.

2. Separate forms for each case: Use a separate claim form for each pet, each illness or injury, and each treating veterinary practice to keep everything organized and prevent confusion.

3. Clinical history is essential: If this is your first claim for your pet, include a complete clinical history from all veterinary practices where your pet has been treated, along with information from any previous owners.

4. Timely reporting: Provide the date you first noticed signs of illness or injury before scheduling your vet appointment. This detail is crucial for the smooth processing of your claim.

5. Choose how to receive payment: Indicate whether you want the claim amount paid directly to your vet or to yourself. If paying the vet, verify that this arrangement has been pre-approved with them.

6. Include all necessary documents: Ensure you submit all itemized invoices and receipts with your claim form. Incomplete submissions will be returned, which can delay your reimbursement.

7. Review privacy and consent: Familiarize yourself with the privacy statement and ensure that all information provided is truthful. Understand that your claim may be refused if inaccuracies are found.