NHI FORMS – National Health Insurance

NHI - GENERAL FORMS

Employer Registration Form

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Employee Registration Form

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Child Registration Form

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Unemployed Spouse Declaration Form

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Self-Employed Registration Form

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Prisoner Registration Form

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Indigent Registration Form

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Senior Citizen Registration Form

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Voluntary Contributor Registration Form

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Employer Contribution Remittance Form

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Notice Of Appeal Form

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Termination Certificate Form

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Notification Of Change Form

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Healthcare Provider Application Form

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Application For Overseas Medical Treatment Form

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Application For Return of Contributions Form

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Prisoner Release Form

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ADULT CARD RENEWAL FORM

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CHILD CARD RENEWAL FORM

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Claim For Medical Expenses Form

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Self-Employed Monthly Remittance Form

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Voluntary Contributor Monthly Remittance Form

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Certificate Of Good Standing Application

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Certificate Of Earnings Application

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Certificate Of Earning - Work Permit Renewal Application

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NHI - HEALTHCARE PROVIDER'S FORMS

Healthcare Providers Form Instructions

Please download or save the form to your local computer.
Fill out the form. Then click the submit button to send the form to the NHI Clinical Team.
After you fill out the form on your local computer, you have the option to save the form and print the form for your records.

Appeal Form | Form AP-001

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Preauthorization Request Form | Form BA-001

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Primary Care Provider Referral Form | Form BA-002

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Pharmacy Preauthorization Request Form | Form BA-003

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Pharmacy Appeal Request Form | Form BA-004

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Important:

Make sure you have Adobe Acrobat Software installed on your machine, not the Reader but the software. If you don’t, you can download it by clicking the download link below.

Download Adobe Acrobat Software