Plan Management Reimbursement Form

NDIS Reimbursement Request

and Reasonable & Necessary Form

PARTICIPANT DETAILS

This form can be used for Reimbursement Requests or as a Reasonable and Necessary Ackowledgment to support the purchase of supports or services.

Is this a reimbursement request for a service or product you have already paid for?

YesNo

Participant’s Full Name *

NDIS Number

Date of Birth *

Email *

Reimbursement Details

Item's or Service Purchased

Name of Business or Provider the service/support was purchased from

Invoice or order number

Total claim amount (in Australian dollars)

Funding Category for this claim

What type of documentation are you attaching to this claim?

Attach these documents here

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Reasonable & Necessary Self Assessment

What does Reasonable and Necessary mean?
The NDIS funds a range of supports and services which may include education, employment, social participation, independence, living arrangements and health and wellbeing. In order to be considered reasonable and necessary, a support or service:

must be related to the disability that the participant is funded for
must not include day-to-day living costs not related to your disability support needs, such as groceries
should represent value for money
must be likely to be effective and work for the participant, and
should take into account support given to you by other government services, your family, carers, networks and the community.

Reasonable and necessary supports provided by the NDIS will help participants to:

pursue their goals, objectives and aspirations
increase their independence
increase community and workplace participation, and
develop their capacity to actively take part in the community.

Your reasonable and necessary NDIS supports are not intended to replace the informal supports already available to you (unpaid support provided by family, friends, and the wider community) or other formal supports that are covered by an existing system, such as health, and education. You can read further information about reasonable and necessary supports here.

The questions below have been duplicated from page 11 of the NDIS publication Booklet 3: Using your NDIS Plan. The full document is available for download on the NDIS website here.

Only services and products that meet this criteria and the reasonable and necessary definition can be purchased from your NDIS plan.

1. Describe how this purchase relates to the participants / your funded disability:

1a. Describe how the purchase will be used.

1b. Are there any potential safety risks?

2. Will the support or service help you to achieve the goals in your NDIS plan?

YesNo

2a. Which of the participants / your goals will this purchase help you achieve?

3. Is the cost of the support or service reasonably priced and is it best value for money compared to other supports?

YesNo

4. Can you afford the support or service within your approved NDIS budget? Remember, your funding needs to last the entire period of your plan.

YesNo

5. Will the support or service help you to improve how you connect to your local community and improve the relationships you have with family and friends?

YesNo

6. Is the support or service something that should be funded by other government services instead?

YesNo

7. Will the support or service help you to participate in activities with friends and other members of your community, or help you to find or keep a job?

YesNo

8. Is it safe? Your supports and services should not cause you any harm or put other people at risk.

YesNo

9. The support on the "Supports that are NDIS supports" list?

YesNo

10. Is the support specified in the plan document?

YesNo

Who can help if you still aren’t sure?

If you are still unsure, you can call the NDIS directly on 1800 800 110, call your LAC or NDIA Planner listed in your NDIS plan document, or contact your Support Coordinator or Boon Plan Management for advice.

Authorisation and Acknowledgement

By signing and submitting this document, I confirm that:

I have applied the Reasonable and Necessary Test and believe the above purchase relates to the goals and disability for which this NDIS plan relates.

*

I have review the NDIS Supports Lists and am not knowingly claiming for a support that is not an NDIS support.

*

I am aware that during an audit process, NDIS may disagree with my assessment and require me to refund the cost of this purchase.

*

I accept full responsibility should I be required to refund any amount to the NDIA, and will work with Boon Consulting to ensure that any debt raised is resolved as quickly as possible.

*

I will not hold Boon Consulting financially liable for any decision I have made on how to spend the funds in my NDIS Plan.

*

Participant/Representative Signature *

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Participant/Representative Name *

Date *

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