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Forms

Forms are published as PDF documents. For more information read the PDF guidelines.

CINICO Care Pay Card Registration Form

 

Health Questionnaire Form

 

Incident / Complaint Form

 

SHIC Plan Enrollment Form

CINICO health care coverage enrollment and eligibility.

Government Entities Plan Enrollment Form

CINICO health care coverage enrollment and eligibility

Application for Direct Debit

Application form for direct debit payment for monthly SHIC premium.

Claim Form

Health Insurance claim form. Instructions on how to correctly file your claim.

Change in Member Circumstance

SHIC members.

Change in Member Circumstance

Government Entities.

CINICO Card Replacement Form

Card replacement request form.