1. Documents
  2. Forms
  3. Forms

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