Forms

The Forms are intended for CHIS Members and must be completed to request one or more benefits from the Third-Party Administrator UNIQA.

Name of document	Type of document
CHIS/F01 – Claim for reimbursement of medical expenses	Form
CHIS/F02 – Declaration of a non-occupational accident	Form
CHIS/F03 – Estimate for dental and orthodontic treatment and prostheses	Form
CHIS/F04 – Request for advance reimbursement	Form
CHIS/F05 – Claim for Long-term care benefits	Form
CHIS/F06 – Prior approval: expenses for cures and convalescence stays	Form
CHIS/F07-Prior approval: Transport/Auxiliary appliances/Refractive surgery/Infertility treatment	From