Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application form. This action will open the form for you to begin filling it out.
2. Carefully review the health plan options available under Rocky Mountain Health Plans. Select one plan that best suits your needs. Remember, only one plan can be selected.
3. Fill in the required personal information fields, including first name, last name, date of birth, and social security number for all enrolling family members. Ensure all details are accurate and complete.
4. Complete the Replacement of Coverage Information section. If you have existing insurance, indicate whether you intend to replace it with the new plan and provide the required details.
5. Move to the Individual Health Plan - Billing Form section. Fill out the necessary billing and payment information including your preferred payment option.
6. Sign and date the form to authorize your selected plan and confirm the information provided is true and complete.
7. Once you have filled in all sections of the form, review it for completeness. After confirming all information is accurate, you can save your changes, download, print, or share the completed form.

Start your health care coverage application process online today!