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  1. Home /
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  3. Claims, provider payments and entitlements

Claims, provider payments and entitlements

We're here to support our healthcare providers. There are many claims, provider payments, subsidies, and entitlements you can apply for through us.
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  • Accessing dialysis while on holiday

    Dialysis for eligible patients within New Zealand while on holiday is available free of charge.
  • Agreement management

    New agreements are created by Sector Operations on behalf of the commissioners of health services. These agreements are based on standard templates.
  • Artificial eyes subsidy

    This subsidy is paid to service providers when a patient has had an eye removed.
  • Breast prosthesis subsidy

    These payments help to reduce the cost of purchasing breast prostheses and other related products.
  • Care Plus

    Care Plus is a primary health care funding initiative to support people with high health needs.
  • Carer Support Subsidy

    The Carer Support Subsidy is available for older people and people with other health conditions who need support.
  • Care and Support Worker proposed wage increase

    A 3% wage increase for care and support workers from 1 July 2023 has been proposed by Health NZ, peak bodies and unions.
  • Community Services Card

    The Community Services Card (CSC) helps people and their families with the costs of health care.
  • Contact lens subsidy

    This subsidy is available to optometrists and dispensing opticians if they have an agreement with us.
  • Dental claim and enrolment forms

    We provide funding for some child and adolescent oral and dental health services.
  • General Medical Services claims

    GMS are subsidies paid to general practitioners under the Section 88 notice to help reduce patient fees for children and subsidy card holders.
  • High Use Health Card

    The High Use Health Card (HUHC) gives a general practice a higher government subsidy for patients with high health needs.
  • Immunisation subsidy

    A subsidy for GPs who give vaccines to eligible patients and submit claims to Sector Operations.
  • In-between travel settlement

    Home and community support workers can be paid for travel between clients, known as 'in-between travel'.
  • Laboratory payments

    A laboratory can submit a claim when a medical practitioner, oral surgeon, cervical smear taker, approved nurse or midwife refers a patient to them.
  • Maternity claims

    Authorised doctors and midwives can claim for the maternity services they provide to New Zealanders.
  • Mental health payments

    The Mental Health Service Payment allows a GP to claim a fee if they are called to assess someone for treatment under the Mental Health Act.
  • National Enrolment Service

    Information on the National Enrolment Service, how it is being implemented, and what this means for PHOs and general practice.

  • National Health Index

    Find out about National Health Index (NHI) numbers, who is entitled to them and how to register a patient for one.
  • National Health Index entitlements

    Learn more about National Health Index entitlements
  • Needs assessment and service coordination forms

    This is the standard national form for Needs Assessment Service Coordination agencies to record eligibility and service coordination information.
  • Nicotine replacement therapy

    The NRT programme aims to reduce tobacco consumption and to improve the health and lifestyle of New Zealanders.
  • Patient refund service payment

    This 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 subsidy.
  • Pharmaceutical co-payment

    Most people who are eligible for publicly-funded health and disability services will pay a maximum of $5 to pick up each subsidised medicine.
  • Pharmacy claims

    Pharmacy claims cover the medicine subsidy and dispensing costs associated with supplying prescribed pharmaceutical items to patients.
  • Practice nurse subsidy

    The practice nurse subsidy is available to GPs under the Section 88 notice to help them employ a registered nurse.
  • Primary health organisations payments

    PHOs are funded to support general practices to provide essential primary health care services to people enrolled with the PHO.
  • Provider payments

    Sector Operations provides a variety of payment-related services for health providers.
  • Research and evaluation of primary health care initiatives

    As part of the Primary Health Care Strategy a number of evaluations were carried out. The following information is based on historical initiatives.
  • Residential care subsidies

    People who need long-term supported accommodation due to illness or a disability may be entitled to access one of three subsidies.
  • Salary subsidy service payment

    Salary subsidies for Wesley Wellington Mission, for doctors employed as medical officers for Wesley Haven and Wesley Ewart hospitals.
  • Sector operations resources

    Resources such as claim specifications and guidelines.
  • Services to improve access

    A key priority for Primary Health Care is to enable groups with the greatest need to access services to improve their health.

  • Special Authority

    Special Authority is an application process in which a prescriber requests government subsidy on a Community Pharmaceutical for a particular person.
  • Special Sessional Scheme payment

    The Special Sessional Scheme service payment or ‘subsidy under the Triple S Scheme’ is for GPs supporting community health education programmes.
  • Stump sock subsidy

    The Stump Socks Service Payment is available when claiming artificial aids.

  • Unvaccinated in-home family carers reimbursement

    About reimbursement for unvaccinated in-home family carers
  • Wigs and hairpieces subsidy

    These payments help to reduce the cost of purchasing and maintaining a wig or hairpiece or other related products.

Also in this section

  • For health providers
    • Aged residential care
    • Claims, provider payments and entitlements
      • Accessing dialysis while on holiday
      • Agreement management
      • Artificial eyes subsidy
      • Breast prosthesis subsidy
      • Care Plus
      • Carer Support Subsidy
      • Care and Support Worker proposed wage increase
      • Community Services Card
      • Contact lens subsidy
      • Dental claim and enrolment forms
      • General Medical Services claims
      • High Use Health Card
      • Immunisation subsidy
      • In-between travel settlement
      • Laboratory payments
      • Maternity claims
      • Mental health payments
      • National Enrolment Service
      • National Health Index
      • National Health Index entitlements
      • Needs assessment and service coordination forms
      • Nicotine replacement therapy
      • Patient refund service payment
      • Pharmaceutical co-payment
      • Pharmacy claims
      • Practice nurse subsidy
      • Primary health organisations payments
      • Provider payments
      • Research and evaluation of primary health care initiatives
      • Residential care subsidies
      • Salary subsidy service payment
      • Sector operations resources
      • Services to improve access
      • Special Authority
      • Special Sessional Scheme payment
      • Stump sock subsidy
      • Unvaccinated in-home family carers reimbursement
      • Wigs and hairpieces subsidy
    • Contract information
    • Education sector
    • The pay equity framework
    • Primary care
    • Primary maternity care
    • Publicly funded health and disability services
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