All the forms you will need

eForms

Welcome to eForms!

In this section, you will find electronic forms to assist you in enrolling and changing
your enrollment status in your CNIC-administered employer group plan.

Member Instructions	Employer Instructions	FORMS:
		Change Form
How to Download Forms
		Claim Form
		Enrollment Form
		Declaration of Common Law Marriage
		Declaration of Domestic Partnership

How To Download Forms

Select the download option that works best for you.

Download Option #1 (Quick)

1. Right click on a form link and Save Target As...
2. The Save As dialog box will appear.
3. In the Save in field (top of dialog box), select your system's Local Disk (C:) and save the file.
4. The form is now saved on your system and ready for you to complete and proceed to instructions below.
   

Download Option #2

1. Click on a form link to open the form file (Microsoft® Word)
2. Once the form is open, complete the form by using the tab key to move from field to field or proceed to Step 3 if you want to fill out the form later.
3. To save the form file to your system, go to the Microsoft® Word tool bar and select File then select Save As...
4. The Save As dialog box will appear.
5. In the Save in field (top of dialog box), select your system's Local Disk (C:) and save the file.
6. The form is now saved on your system and ready for you to either complete and/or proceed to instructions below.

Member Instructions

Submit Enrollment and Change Forms

1. Follow one of the download instructions above
2. Complete the form
3. Print and sign your form
4. Submit your form to your group's Human Resources Department. They will forward the form(s) to CNIC.

Submitting Your Form via E-mail to Your Human Resources Department

You may have the option of submitting your enrollment and change forms to your Human Resources Department via e-mail. Please check to see if they will accept the electronic form prior to sending it. If electronic submission is acceptable, please be sure to discuss with your Human Resources Department the type of protection to be placed on the document and/or e-mail to prevent viewing of the information by unintended recipients.

Member Instructions

Submit Claim Forms

The submittal process for Claims forms is different from submitting other forms. You can mail Claims forms directly to CNIC.

1. Follow one of the download instructions above
2. Complete the form
3. Print and sign your form
4. Attach your bill
5. Mail or fax your form and attached bill directly to CNIC at:

CNIC
P.O. Box 76149
Colorado Springs, CO 80970-6149

Fax# 1-719-591-4132

If you have any questions about this process or our on-line forms, please contact our Customer Service Department at 1-877-321-4412

Employer Instructions

Submit Enrollment / Change Forms

Follow the download instructions above, complete the form and submit the forms to CNIC.

Enrollment, Change, Termination Forms

• Mail or fax your form(s) to CNIC at:

CNIC
P.O. Box 76150
Colorado Springs, CO 80970-6150

Fax# 719-591-4550