Wiggle Personal Accident


(If you have it handy)


























Please provide details:


Do you have private health insurance?






















IMPORTANT NOTE REGARDING CLAIMS FOR MEDICAL EXPENSES
We do not provide cover for any account that is fully or partially covered by Medicare. This means that we do not cover expenses claimable from Medicare, nor do we pay the Medicare gap. The reason for this is that the Australian Health Insurance Act does not permit us to do so. Please do not send us any account or receipt for a service that is covered by Medicare. We do cover non-Medicare medical expenses for charges involving private hospital, dental, ambulance, chiropractic treatment, physiotherapy or any similar provider of medical services provided always that such treatment is certified necessary by a legally qualified medical practitioner.



Please provide copies of all invoices for medical treatment received that you are claiming for:


Did you receive a health fund rebate for any of the invoices you are claiming for:









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