Claims, provider payments and entitlements

This section contains pages on the various claims, provider payments and entitlements processed by Sector Services.

In this section

  • Resources such as claim forms and specifications. Read more
  • Adolescent Oral Health Enrolments applications are for patients who are under the age of 18 years and are entitled to free dental care. Adolescent Oral Health Enrolment applications are completed by the patient and the dental provider. Read more
  • New agreements are created by Sector Services on behalf of the funders and Ministry of Health. This page describes how agreements are created, revised and renewed. Read more
  • The Artificial Eyes Service Payment is paid to a supplier when a patient has had an eye removed (the first artificial eye is included in the cost of the surgery). The subsidy is claimable by the supplier of the artificial eye only. Read more
  • The Breast Prosthesis Service Payment is payment to people who have undergone a partial or full mastectomy, either unilateral or bilateral, and/or have undergone a lumpectomy, have congenital needs, or have had failed reconstructive surgery. Read more
  • Care Plus is a primary health care initiative targeting people with high health need due to chronic conditions, acute medical or mental health needs, or terminal illness. Read more
  • Resources to help with claiming the Carer Support subsidy, including a brochure on how to claim Carer Support, and a sample copy of the claim form. Read more
  • The contact lens subsidy is available to optometrists and dispensing opticians who fit or supply patients who, for medical reasons, cannot wear glasses. Read more
  • Dialysis for patients within New Zealand while on holiday is available free of charge. Read more
  • The dental subsidies are available to dentists who have provided services to children under the age of 18. Read more
  • General Medical Subsidies are paid to general practitioners to help reduce patient fees for children and subsidy card holders. Read more
  • The High Use Health Card offers the same benefits of a Community Services Card, for general practitioner visits and prescription charges. Read more
  • The immunisation subsidy is for general practitioners who administer vaccines to eligible patients and submit claims to Sector Services. If a claim is submitted to Sector Services, the general practitioner cannot charge the patient for the service that was provided. Read more
  • A laboratory payment is where a patient is referred by for a laboratory test. To receive payment for the test, the laboratory submits a claim file and/or invoice to Sector Services which Sector Services processes on behalf of the funding district health board. Read more
  • The Locum Subsidy payment is claimed by GP/Practitioners when they go on holiday or on education leave. This is part of the incentives for becoming a rural practice or provider. This can be provided once a year for a provider. Read more
  • The maternity services payments are claimed by authorised doctors, midwives and specialists to reimburse them for all maternity-related services. New Zealand women are not charged for their maternity care. Read more
  • The Mental Health Service Payment is a fee that allows a general practitioner to submit a claim for a fee if they have been called upon to assess someone needing treatment under the terms of Act. Read more
  • The National Health Index number is a unique identifier assigned to every person who uses health and disability support services in New Zealand. A person’s NHI number is stored on the National Health Index along with that person’s demographic details. Read more
  • If you are eligible for travel assistance, you may be able to claim for kilometers traveled by private car, public transport, accommodation, and specialised transport (such as taxis, mobility taxis, or air travel). Read more
  • The Nicotine Replacement Therapy programme is funded to reduce tobacco consumption and to improve the health and lifestyle of New Zealanders. Read more
  • The notifiable diseases service payment is received by a doctor when notifying a health protection support officer regarding certain diseases. Read more
  • The patient refund service payment is available when a specialist has opted not to claim on behalf of a patient. The patient pays the full amount and collects the available subsidy directly. Read more
  • The practice nurse subsidy is available to general practitioners to help them employ a registered nurse. The practice nurse must be performing medical duties to be eligible for the subsidy. Read more
  • Primary health organisations (PHOs) are funded by district health boards to support the provision of essential primary health care services through general practices to those people who are enrolled with the PHO. Read more
  • Sector Services provides a variety of payment-related services for health providers. This page includes information on provider and facility registration and maintenance. Read more
  • Pharmacy claims cover the medicine subsidy and dispensing costs associated with supplying prescribed pharmaceutical items to patients. Read more
  • People who require long-term supported accommodation due to an illness or a disability may be entitled to access one of three subsidies: the Residential Care Subsidy, the Residential Support Subsidy, or the Top-Up Subsidy. Read more
  • Salary subsidies are only paid to one payee – the Wesley Wellington Mission, for doctors employed in the capacity of medical officers for their Wesley Haven and Wesley Ewart hospitals. Read more
  • Special Authority is an application process in which a prescriber requests government subsidy on a Community Pharmaceutical for a particular person. Read more
  • Special Authority is an application process in which a prescriber requests government subsidy on a Community Pharmaceutical for a particular person. Read more
  • The Special Sessional Scheme service payment is a subsidy available to general practitioners where it is to be used for encouraging health promotion and health awareness, through continuing education programmes with groups within the local community. Read more
  • The Stump Socks Service Payment is available when claiming Artificial Aids. Read more
  • The Wigs and Hairpieces Service Payment is a payment to people who suffer from serious hair loss because of a medical condition or from certain cancer therapies. The payments are to reduce the cost of purchasing and maintaining a wig or hairpiece or other related products. Read more