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Welcome to the Illinois Department of Insurance
Senior Health Insurance Program (SHIP) Forms application.

Illinois Department of Insurance
320 West Washington Street
Springfield, IL 62767-0001
DOI.SHIP@Illinois.gov
Client Contact Forms should be completed by registered SHIP counselors and coordinators for reporting each contact with a client such as seniors, Medicare or Medicaid beneficiaries or their caregivers, or others working on behalf of the client.  Contacts to be reported include any contacts made via telephone, in person (at site), in person (at home), via postal mail, e-mail, or fax.

Public and Media Activity Forms should be completed to report any activity to the public on behalf of SHIP such as interactive presentations to the public, a booth/exhibit, a radio show (not a public service announcement), web-site events, tv/cable show (not a public service announcement), enrollment event, or other activity reaching the public.   Please complete one form per activity.