Forms

Here you can find all important forms to save and print.

Cancellation of health insurance
A template letter to use when writing to your prior insurer terminating your insurance

PDF 58.34 KB
Contract separation
Helsana

PDF 43.77 KB
Contract merging
Helsana

PDF 43.49 KB

Customer information in accordance with Article 45 of the VAG

PDF 61.73 KB
Customer information according to the VVG
Overview of the insurer and the fundamental parts of the insurance policy

PDF 1.41 MB

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 614.98 KB

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

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 1.43 MB

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 40.58 KB

Power of Attorney - Helsana Group
A copy of an official identity document belonging to the authorising party must be included for identification purposes.

PDF 76.66 KB
Authorisation Helsana+ for minors over the age of 12
Authorisation to participate in the Helsana+ bonus programme

PDF 119.99 KB

Referral (in German)

0 B

Questionnaire relating to tooth damage caused by food
Helsana

PDF 56.76 KB
Dental questionnaire for dental insurance DENTAplus

PDF 95.33 KB

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