Anaesthetists' Supplementary Claim Form

This form is for completion by the Consultant Anaesthetist who provides the services listed below in accordance with the Vhi Healthcare Anaesthesia Ground Rules contained in the Vhi Healthcare Schedule of Benefits for Professional Fees.

Benefits Direct to Member

The following benefits can be claimed using this claim form:

• Return Home Benefit - Available following a hospital stay of 5 days or more on relevant plans
• Parent Accompanying Child - Travel and accommodation expenses for parent/guardian accompanying a child (under 14 years at last renewal date) during that child's hospital stay in excess of 3 days
• Cancer Care Support - Accommodation grant - available when a patient travels for out-patient cancer chemotherapy or radiotherapy treatment and is required to stay overnight in accommodation convenient to the hospital
• Child Nursing - Nursing care at home (for a member under 18 years of age at last renewal date) following a stay in hospital of 5 days or more
• Post-Natal Home Nursing Benefit - Home nursing, by a registered nurse, incurred within 3 days of delivery
• Patient Support - Benefit towards the accommodation costs of a family member as detailed on relevant plans.
• Manual Lymph Drainage - Benefit towards the cost of Manual Lymph Drainage following cancer treatment. The person giving the care must be a Physiotherapist, or Physical Therapist, or a member of MLD (Manual Lymph Drainage) Ireland.

Oncology/Radiotherapy - Day Care & Side Room

This claim form is for submitting Onoclogy/Radiotherapy claims for Day Care & Side Room as specified in your Vhi Healthcare Rules - Terms and Conditions of membership.

Surgical Procedures

This claim form is for submitting surgical procedures claims as specified in your Vhi Healthcare Rules - Terms and Conditions of membership.

Appliance Claim Form

This claim form is for submitting appliance claims. Details for each appliance that you are claiming for must be included.

Hospital Intensive Care Claim Form

This form is for completion by the consultant who provides intensive care medicine in accordance with the Vhi Healthcare Intensive Care Medicine Ground Rules contained in the Vhi Healthcare Schedule of Benefits for Professional Fees.

Neonatal Intensive Care Claim Form

This form is for completion by the consultant who provides neonatal intensive care medicine in accordance with Vhi Healthcare's Neonatal Intensive Care Ground Rules contained in the Vhi Healthcare Schedule of Benefits for Professional Fees.

The Physio Company Claim Form

This claim form is for submitting your Joint Care Programme claims.

HealthSteps Claim Form

This claim form is for submitting day-to-day medical expenses covered by your plan. The cover you have depends on the plan you hold. If you would like information on the benefit provided by your plan please refer to your Table of Benefits and Rules - Terms and Conditions.