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Medicare claim form ms014

Medicare two way claim form 2026

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The document is a Medicare two-way claim/change of address form used in Australia, allowing individuals with private health insurance to lodge claims for in-hospital and ancillary services. It includes sections for member details, electronic funds transfer information, and a claimant's declaration. The form facilitates the process of claiming medical gap benefits and provides instructions on how to submit claims either through Medicare or directly with private health funds.

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Click ‘Get Form’ to open the Medicare Two-Way Claim Form in the editor.
Begin by filling out Section 1, which includes your personal details. Enter your family name, first name, and daytime telephone number. Ensure that you indicate if this is your permanent mailing address.
In Section 3, provide your banking details for Electronic Funds Transfer (EFT). Fill in the name of your private health fund, membership number, BSB number, and account number.
Proceed to Section 4 to answer questions regarding your treatment. Indicate whether you wish to claim the fund medical gap benefit and provide details about the hospitalization dates.
Finally, review the Claimant’s Declaration at the bottom of the form. Ensure all information is accurate before signing and dating the form.

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