Get Colorado Individual Enrollment Application - Anthem

Completing the Colorado Individual Enrollment Application is essential to ensure you receive the health coverage necessary for you and your family. This guide provides a clear and structured approach to filling out the form online, ensuring a smooth and efficient process.

Follow the steps to successfully complete the application

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section A – Coverage Information. Select the application type: 'New Coverage', 'Change Anthem Individual policy coverage', or 'Add dependent(s) to current coverage'. Indicate the effective date you’d like for your coverage.
3. Proceed to Section B – Applicant Information. Fill in all required fields such as social security number, medical plan code, home address, and marital status. Provide accurate information about your height, weight, sex, age, and date of birth.
4. Continue to Section C – Spouse or Domestic Partner Information. If applicable, provide similar detailed information about your spouse or domestic partner.
5. Complete Section D – Child Dependents to be Covered Information. List all eligible dependents under age 19 or up to the age of 24. If additional space is needed, attach a separate sheet.
6. Fill out Section E – Medical Coverage, selecting one plan and deductible. Review all your choices carefully. If you want different plans for each family member, document those in previous sections.
7. Proceed to Section F – Dental Coverage Selection if applicable. Indicate whether you wish to add dental coverage and select the appropriate coverage type.
8. In Section G – Life Insurance Information, decide if you want term life insurance and provide necessary details, if applicable.
9. Move to Section H – Health Insurance Portability and Accountability Act (HIPAA) questions. Answer the yes/no questions related to HIPAA eligibility.
10. Fill out Section J – Health History carefully, as each applicant must answer health history questions. Be thorough and honest in your answers to avoid any issues with coverage.
11. Complete the billing information in Section K. Choose your preferred payment option and provide necessary banking information.
12. Lastly, review Sections L (Significant Terms, Conditions and Authorizations), M (Authorization for Use of Protected Health Information), and N (if applicable). Ensure all signatures are provided where required.
13. Save changes, download, print, or share the completed form as needed.

Complete your Colorado Individual Enrollment Application online today for a seamless health coverage experience.