Claim form - Chamber Primary Health Plan - Westfield Health 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by selecting your title (Mr/Mrs/Miss/Ms/Dr/Other) at the top of the form. This personalizes your claim and ensures accurate processing.
3. If you prefer direct payment, enter your bank account details. Remember, these must be in your name, and only fill this out if your details have changed.
4. In the Marketing Preferences section, indicate whether you wish to receive marketing communications. Opt-out if desired by contacting the provided address.
5. For claims related to a dependent child, fill in their name and date of birth. Confirm their residency with you by selecting 'Yes' or 'No'.
6. Complete the Declaration and Signature section, ensuring all information is accurate. This is crucial for claim validation.
7. Select the benefits you are claiming from Part 2 and attach relevant receipts for each treatment type listed.

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