Health and life insurance forms 

About the forms

• Health insurance claim form (includes application for pre-approvals) - For pre-approval and claims on health insurance policies.
• Direct Debit Authority form - Used to set up direct debit premium payments to TOWER Health & Life.
• Credit Card Authority form - Used when you are changing your payment method for TOWER Health & Life premiums to a credit card payment option.
• Smoking Status Questionnaire form - Some of TOWER Health & Life's policies use smoking status as one of the factors to help determine the premium. If you have stopped smoking and meet the non-smoking criteria, you may be eligible for a discount on your premiums. The Smoking Status Questionnaire form is used when: - You become classes as an 'adult' on your parents' health policy, or - You were a smoker and are now a non-smoker and can declare that you have not smoked any form of tobacco or any other substance in the last 12 months.
• Additional Children Application form (health insurance) - Used to add your children onto your health policy with TOWER Health & Life if they are over four months and under 16 years of age. If your child is under four months old, you can add your child onto your health policy without the need for an application form. Simply provide TOWER with your child's name, date of birth and gender by phoning 0800 379 372.
• Declaration of Health form (health insurance) - If your cover with TOWER has been cancelled due to premium arrears, and you wish to reactivate this cover, print off and complete the Declaration of Health form, sign and date it, and return to our office by post within three months from the date cover was cancelled with TOWER. Please enclose payment for the arrears, and your policy will be assessed for reinstatement. Please note that changes to your policy could be applied.
• Declaration of Health form (life, income protection, serious care/trauma insurance policies) - If your cover with TOWER has been cancelled due to premium arrears, and you wish to reactivate this cover, print off and complete the Declaration of Health form, sign and date it, and return to our office by post within three months from the date cover was cancelled with TOWER. Please enclose payment for the arrears, and your policy will be assessed for reinstatement. Please note that changes to your policy could be applied.
• Prosthesis schedule - A list of prostheses covered by us and the specified benefit maximum.
• Prosthesis schedule for Priority Health Business™ only - A list of prostheses covered by us and the specified benefit maximum.
• Usual, customary and reasonable charges guidelines - Our estimate of what are usual, customary and reasonable maximum charges by health service providers based upon a pool of prior claims.

Life, trauma, permanent disability and income protection claims

Depending on the claim being made, we require different types of information. To claim on one of these policies please contact us on 0800 379 372.

Health Insurance claims

Before having a surgical procedure we recommend that you obtain pre-approval, so you know that the procedure you require will be covered. You will need to submit a pre-approval request and allow TOWER at least five working days to assess and process your pre-approval request.

To make a claim:

Please download the Health Insurance Claim form above.

Fill out all the sections of the form that apply to the claim you are making and refer to the table below:

Attach the additional information requested in each section of the form that applies, print off the form and sign. Either fax the claim form to 0800 345 134 or post it to:

TOWER Health & Life Limited
PO Box 6547
Wellesley Street
AUCKLAND 1141

Once we have received all the information required, we aim to assess and process your claim within five working days. Please note there will be a delay if we have to request additional information.

If you require any assistance please contact us on 0800 379 372.