Forms & Reports

Citizenship and Application for Health Insurance
Paper Application Materials
Miscellaneous Forms
Consumer Reports
Feedback

Citizenship and Application for Health Insurance

If you are not a U.S. citizen, you may still qualify for health insurance, but may need to include additional information from documents like an employment card, I-94 or Legal Permanent Resident card. After you submit your application, we may send you a letter asking you to provide a copy of your document so that we can double-check your immigration status. This information is only used to determine what type of health insurance you may qualify for. It will not be used by or shared with the U.S. Immigration and Customs Enforcement agency.

Below are some examples of common immigration documents. These can be used as a reference to locate your card or document number, non-citizen number and class code. If you cannot select your immigration information from the drop down selections in the application, please mark “Other”. This will not prevent you from being eligible, but may require additional verification be provided.

Paper Application Materials

If you prefer to complete your application by mail, here are downloadable 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 Health Insurance with Financial Assistance on the Marketplace

This is the form you will want to use to apply for one of the Insurance Affordability Programs: Health First Colorado (Colorado’s Medicaid Program), Child Health Plan Plus (CHP+) and the Premium Tax Credits and/or Cost-Sharing Reductions.

  • Individual Application with Financial Assistance – Spanish coming soon

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 – to come

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.

Small Business Life Change Event Form – use this form to report changes within 30 days of a qualifying life change event.

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.

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 file it with the Marketplace.

Authorizing, Changing or Revoking an Authorized Representative Form

THIS FORM IS NOT TO AUTHORIZE A BROKER OR ASSISTER TO ACT ON YOUR BEHALF. To approve a Broker or Assister to act on your behalf, please log into your account and select ”GET ASSISTANCE”. Note: Brokers and Assisters may not serve as authorized representatives.

Miscellaneous Forms

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 Health First Colorado (Colorado’s Medicaid Program) 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.

Consumer Reports

Qualified Health Plan Enrollee Experience Survey
This report by the Centers for Medicare & Medicaid Services evaluates enrollee experiences with Qualified Health Plans offered through Health Insurance Marketplaces and the Small Business Health Options Program.

2017 Health Insurance Exchanges: Evaluating the Online-Comparison Shopping Experience
A third party, non-partisan healthcare group ranked the Connect for Health Colorado® website second among the 12 state-based health insurance marketplaces and HealthCare.gov, in a report card.

Feedback

We want to hear from you. Let us know how we can improve on your experience with Connect for Health Colorado. Share your feedback.