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 or members of your household are eligible for, 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
Non-Citizen 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 you or members of your household may be eligible for including 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 65 , 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 Colorado PEAK or Connect for Health Colorado’s website, fax them to (855) 346-5175, submit copies of 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.

For more information, see the “What is Essential Minimum Coverage?” FAQ.

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