New CERN Health Insurance Scheme (CHIS) forms

New versions of the following forms for claims and requests to the CERN Health Insurance Scheme (CHIS) have been released:


  • form for claiming reimbursement of medical expenses,
  • form for requesting advance reimbursement, and
  • dental estimate form (for treatments foreseen to exceed 800 CHF).


The new forms are available in French and English. They can either be completed electronically before being printed and signed, or completed in paper form. New detailed instructions can be found at the back of the claim form; CHIS members are invited to read them carefully.

The electronic versions (PDF) of all the forms are available on the CHIS website and on the UNIQA Member Portal.

CHIS Members are requested to use these new forms forthwith and to discard any previous version.

Questions regarding the above should be addressed directly to UNIQA (72730 or 022.718 63 00 or

by HR Department