Utah health insurance application 2026

1. Click ‘Get Form’ to open the Utah Health Insurance Application in our editor.
2. Begin by filling out the 'Reason for Enrollment' section. Mark all applicable reasons such as 'New Group', 'Marriage', or 'Loss of Coverage'.
3. In section A, provide your employer's information. If applicable, indicate if this is a division and name the parent company.
4. Move to section B and enter your personal details including your name, job title, employment status, marital status, and contact information.
5. In section C, list yourself and any dependents applying for coverage. Ensure you include their names, dates of birth, and gender.
6. Complete section D by indicating any current health care coverage for each person listed. This helps determine benefit coordination.
7. Finally, review the acknowledgment in section E. Sign and date the form to confirm that all information is accurate before submitting.

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