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HEALTHY LIFESTYLE PROGRAM FORM - …

HEALTHY LIFESTYLE PROGRAM FORMCHECKLIST Choose your approved PROGRAM provider Complete this form in conjunction with your treating medical practitioner or allied health provider Submit your claim ensuring that all declarations are signed and that the original accounts or receipts are attached Leaving a section blank or without the required information may delay the processing of your claimUPDATED APRIL 2019Am I eligible to claim a HEALTHY LIFESTYLE benefit?The HEALTHY LIFESTYLE Benefit is available under all Teachers Health Extras products, providing practical support to help you reach your health-related goals by covering some of the costs of approved health-related programs .

HEALTHY LIFESTYLE PROGRAM FORM CHECKLIST • Choose your approved program provider • Complete this form in conjunction with your treating medical practitioner or allied health provider

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