This page offers ways for customers to access resources and provide feedback.

Do you need information about your consumer rights regarding health insurance? The Colorado Division of Insurance can help. You can contact them at 303-894-7490 or visit their website for more information or to file a complaint.

Do you have questions about public health coverage such as Medicaid or Child Health Plan Plus? The Colorado Department of Health Care Policy and Financing can help. You can contact them at 303-866-3513 or 800-221-3943 or visit their website.

You can register to vote at www.govotecolorado.com.

Application Materials

Here are paper forms you can use to apply for help with costs and/or health coverage through Connect for Health Colorado. Please remember that the quickest determinations will be made if you apply online. Spanish versions of many of these forms will be available soon.

Application for Financial Assistance on the Individual Marketplace
This is the form you will want to use to apply for one of the Insurance Affordability Programs: Medicaid, Child Health Plan Plus (CHP+), and the Advanced Premium Tax Credits and/or Cost Sharing Reductions.

Application for Health Insurance without Financial Assistance on the Individual Marketplace
These are the forms you will fill out if you would like to purchase a Qualified Health Plan without financial assistance. Please be sure to complete both the Individual Application Without Financial Assistance and the Individual Application Addendum forms. Both forms must be mailed to Connect for Health Colorado in order to process your application.

Application for Employers on the Small Business Marketplace
These forms should be used if you are an employer applying for coverage through the Small Business Marketplace. Please be sure to complete the Employer Application. Also complete Worksheet A, if applicable.

Application for Employees on the Small Business Marketplace
These forms should be used if you are an employee whose employer is offering coverage to you through Connect for Health Colorado. Please be sure to complete the Employee Application and Employee Addendum. Also complete Worksheet A, if applicable. Please return all forms to your Employer when complete.

Report Account and Enrollment Changes
These forms provide a way for you to report new circumstances that may allow you to update your current plan at any point in time or to enroll in a new health plan outside of the open enrollment period. Please note that any changes to your account must be reported to the Marketplace within 30 days of the change.

Report Account and Enrollment Changes Form – Individual Marketplace
Who should use this form?

  • Current customers who are already insured through Connect for Health Colorado and need to make changes at any point in time.
  • Current customers who are already insured through Connect for Health Colorado who do not have financial assistance to help with costs but whose account or enrollment change will allow them to apply for help with costs at any point in time.
  • New customers whose account or enrollment change allows them to enroll in a new health plan outside of the open enrollment period.

Note: You will likely only have to fill out part of this form.

Report Account and Enrollment Changes Form – Small Business Marketplace
Who should use this form?

  • Employers who already insure their employees through Connect for Health Colorado (the Small Business Marketplace) and need to make changes at any point in time.

Authorizing, Changing or Revoking an Authorized Representative form

An Authorized Representative is a trusted person who you can give permission to talk to us on your behalf about an application or appeal request with the Marketplace. Once you give another person authority to act as an Authorized Representative they can: see your information, and act for you on matters related to the application or appeal, including getting information about your application or appeal request and signing your application or appeal request on your behalf.  A common example of an Authorized Agent is a power of attorney. This person takes legal responsibility for the information provided on your application or appeal request. If you do not want an Authorized Representative, you do not need to fill out this form.

Who should use this form?

  • CURRENT CUSTOMERS: If you want to authorize a representative and did not do so when you originally filled out your application, you must use this Authorized Representative Form to authorize a representative.
  • NEW CUSTOMERS: We recommend if you plan to authorize a representative that you also fill out the Authorized Representative Form and put it on file with the Marketplace.

THIS FORM IS NOT TO AUTHORIZE AN AGENT, BROKER, OR HEALTH COVERAGE GUIDE TO ACT ON YOUR BEHALF. To approve an Agent, Broker or Health Coverage Guide to act on your behalf, please log into your account and select GET ASSISTANCE. Note: Agents, brokers, health coverage guides, and other Connect for Health assisters may not be authorized representatives.

 Miscellaneous Forms

There are hardship circumstances under which you may be eligible for a Catastrophic (CYA) plan.  For more information on that and applying for an exemption from the federal requirement to have health insurance, please visit our Federal Requirements page.

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