Nebraska Department of Insurance

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THE NEBRASKA SENIOR HEALTH INSURANCE INFORMATION PROGRAM (SHIIP) VOLUNTEER SITE

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The Nebraska SHIIP relies heavily on volunteer counselors that assist Medicare beneficiaries in their communities. The SHIIP currently has over 200 volunteers across the state.

Interested in Becoming a SHIIP Volunteer?
• Volunteer Recruitment Brochure
• Nebraska SHIIP Regions

Electronic Forms
• Client Contact Form
• Public & Media Outreach Form

SHIIP Manual Forms - Section O
• Volunteer Protection Act of 1997
  
• Client Contact Form
  
• Public & Media Outreach Form
  
• Expense Report Form
  
• CMS Complaint Form
  
• Brochure Order Form
  
• Nebraska Department of Insurance Complaint Form
  
• Advanced Beneficiary Notice (ABN)
  
• Insurance Claims Record Worksheet
  
• Beneficiary Authorization Form - Medicare Part A/Part B
  
• Notice To All SHIIP Clients
  
• Authorization for Disclosure of Protected Information
  
• Social Security Limited Income Application for Part D
  
• Part D Determination Request Form
  
• SHIIP Personal Information Worksheet for Part D