Are there certain documents or information I need to fill out an application, and how do I submit them?

When you apply for financial assistance through Connect for Health Colorado, we will ask you for information about your household, including who is in your household, annual income, any insurance you currently have, and some additional items. The checklist below can help you gather what information you may need during the application process:

  • Applicant/non-applicant address information
  • Social Security Numbers of each member of the household (or document numbers for lawfully present individuals)
  • Birth dates
  • Employer and income information for each member of the household (for example, wage and tax statements such as pay stubs or W-2 forms)
  • Information about any other income earned by household members Information and policy numbers for health insurance plans currently covering members of the household Information about any job-related health insurance that anyone in the household may be able to get, even if they are not enrolled in it If anyone in the home is disabled, receiving Medicare, or over 64, asset and expenses information for the household (this may allow the customer access to additional programs)
  • Names of preferred health care providers
  • Documents verifying your authorized representative (if applicable)

 

Submitting Your Documents: You can upload your documents online through the PEAK or Connect for Health Colorado website, fax them to (855) 346-5175, submit them by mail (Connect for Health Colorado, Verifications, P.O. Box 35681, Colorado Springs, CO 80935), or in person at a local Assistance Site or through a certified agent/broker. Individuals who submit copies of their documents should write their account number on the document.