Colorado Application Submission Instructions

PW_E178912
 
Colorado Insurance Regulation 4-2-36 requires all health insurance carriers issuing individual health benefit plans to present a Prescreening Questionnaire Form to all applicants requesting coverage for January 1, 2012 or later effective dates. The questionnaire is short and simple, and asks specific health history questions that require “Yes” or “No” answers. The purpose of the questionnaire is to help applicants quickly determine if they have a condition that makes them eligible for CoverColorado (and ineligible for commercial coverage). It will allow the applicant to avoid completing a long form carrier application only to be declined and directed to CoverColorado.  
Upon review of the form: 
If you or any family member age 19 or older applying with you check “No” to all conditions, you can complete the Anthem Individual Enrollment Application and submit it to Anthem as usual.
If you or any family member age 19 or older applying with you check “Yes” to any condition, please complete and submit the Prescreening Questionnaire Form for that person only. The rest of the applicants can apply using the Anthem Individual Enrollment Application and submit it to Anthem as usual.
 
Quick Links 
Prescreening Questionnaire Form (PDF)
Anthem Individual Enrollment Application (PDF)
PlanFinder (our Online Application tool)
CoverColorado (this link will redirect you out of the Anthem.com site)

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use