Forms
Here you can find all important forms to save and print.
Contracts and cancellation
Cancellation of health insurance
A template letter to use when writing to your prior insurer terminating your insurance
PDF
41.98 KB
Contract separation
PDF
84.59 KB
Contract merging
PDF
82.44 KB
Customer information
Customer information in accordance with Article 45 of the VAG
PDF
60 KB
Customer information according to the VVG
Overview of the insurer and the fundamental parts of the insurance policy
PDF
116.38 KB
Illness or accident abroad
Payment of costs for a planned hospital stay abroad
Application for payment of costs for a planned hospital stay abroad under Supplementary Hospital Insurance
PDF
38.44 KB
Illness or Accident abroad
Survey on illnesses or accidents while abroad
PDF
617.22 KB
Insurance card
Blocking of the electronic information service provided by your insurance card
Helsana recommends all customers to maintain the electronic information service. - Only available in German, French and Italian
PDF
172.68 KB
Legal expenses cases
Notification of legal protection claim
Notification of a claim under healthcare and legal expenses insurance abroad, or under civil and motoring legal expenses insurance - only available in German, French and Italian
PDF
1.44 MB
Payments
For private customers: Bank direct debits (LSV) & Swiss Direct Debit (CH-DD)
Payment authorisation form for bank or postal accounts
PDF
53.88 KB
Form account details
account details
PDF
29.26 KB
Power of attorney
Power of Attorney - Helsana Group
A copy of an official identity document belonging to the authorising party must be included for identification purposes.
PDF
76.55 KB
Authorisation Helsana+ for minors over the age of 12
Authorisation to participate in the Helsana+ bonus programme
PDF
141.14 KB
Sickness and accident
Accident notification (PDF, 40.83 KB)
Accident notification for children (PDF, 23.59 KB)
Krank- und Unfallmeldung Einzel-Taggeldversicherte (PDF, 137.6 KB)
Tooth damage
Questionnaire relating to tooth damage caused by food
PDF
17.72 KB
Dental questionnaire for dental insurance DENTAplus
PDF
96.57 KB
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