Publications & forms

Publications & forms

Download one of our publications or member forms.

Publications

2017 Health Cover Brochure
Information correct as at April 2017

2017 Just Ask!® Brochure
Information correct as at June 2017

2017 Student Dependant
Registration Form

Information correct as at January 2017

 

2017 Participating Private Hospitals List
Information correct as at September 2017

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

Australian Government Rebate Form (Interactive PDF)
Download, complete and return the Australian Government Rebate 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, psychiatric benefit limitation period, default and limited benefits, restricted benefits, limits, co-payment and excesses may apply. Please refer to the terms and conditions of waiting periods.

Latrobe Member Claim Form
Download and complete the Member Claim Form. Send it to Latrobe with your original provider invoices and we can deposit your payment directly into your nominated bank account.

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

Latrobe Orthodontic Form
Download, complete and return the Orthodontic Form to Latrobe Health Services.

Medicare Claim Form (MS014)
If you are claiming for medical services provided whilst you were in hospital, you will need to complete a Latrobe Member Claim Form and the Medicare Claim Form. We will forward your accounts and the Medicare Claim Form to Medicare on your behalf.
If you have already paid your medical account just complete a Latrobe Member Claim Form and forward this with your Medicare Statement of Benefits.

If you lodge your claims directly with Medicare no additional benefits can be paid without a Latrobe Member Claim Form being completed. Therefore we encourage you to submit your claims to Latrobe in the first instance to ensure you receive your maximum benefit.

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.