Get Claim For External Breast Prostheses Reimbursement Program - Humanservices Gov

Filing a claim for the External Breast Prostheses Reimbursement Program is an important step to help individuals recover some costs associated with their prosthesis purchases. This guide provides a clear, step-by-step approach to successfully complete the claim process online.

Follow the steps to complete your claim efficiently.

1. Click ‘Get Form’ button to obtain the form and open it to begin the filing process.
2. Provide your Medicare card number in the designated field, along with your full name, and the details of any refund you have received from your private health fund.
3. Indicate which breast the prosthesis was for by ticking the appropriate box (Left breast or Right breast).
4. Enter your postal address. If this is your permanent postal address, select 'Yes'; otherwise, select 'No'.
5. Fill in your daytime phone number and email address (email is optional).
6. Read and confirm the declaration. Ensure that you agree with all the statements provided regarding the information in your claim.
7. Provide your bank account details where you would like your reimbursement to be transferred. This includes your bank's name, BSB, and account number.
8. Sign and date the form to validate your application.
9. Attach a copy of all relevant receipts to your claim, verifying the purchases made.
10. Once all information is filled out and the receipts are attached, save changes, and consider downloading, printing, or sharing the completed form as needed.

Start your claim online today and take the first step towards receiving your reimbursement.