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Colorado uniform application for health insurance

Colorado Uniform Employee Application for Small Group Health ... 2026

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4.4 out of 5

2004 votes

The document is a Colorado Uniform Employee Application for Small Group Health Benefit Plans, designed for employees to apply for health coverage through their employer. It includes sections for employee and dependent information, medical history, current and previous coverage details, and waivers of coverage. The application requires personal information such as names, social security numbers, and medical history to determine eligibility for health benefits. It also outlines terms and conditions regarding preexisting conditions and late enrollment.

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Click ‘Get Form’ to open the Colorado Uniform Employee Application in our platform.
Begin by entering your personal information in the 'Employee & Dependent Information' section. Fill in your name, Social Security number, date of birth, and contact details.
Indicate your job title and employment start date. Specify your marital status and whether you are on COBRA or State Continuation.
Select the type of coverage you are applying for from the options provided by your employer. Include details about your primary care physician.
List all dependents applying for coverage, including their names, Social Security numbers, and medical plan selections. Ensure to check any applicable boxes regarding their status.
Complete the 'Employee/Dependent Waiver of Coverage' section if you or any dependents are not enrolling. Provide reasons for waiving coverage.
Fill out the 'Current and Previous Medical Coverage' section to provide information about existing health plans.
Answer the medical questions honestly in the 'Medical Information' section. Attach additional pages if necessary.
Review all entries for accuracy before signing and dating the application at the end.

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Versions	Form popularity	Fillable & printable
2013	4.8 Satisfied (161 Votes)
2006	4.4 Satisfied (2004 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is an employee group health plan?

A Group Health Plan (GHP) is health insurance offered by an employer, union or association to its members while they are still working. GHP coverage is based on current employment.

What is the ACA 50 employee rule?

If you have 50 or more full-time employees, including full-time equivalent employees, you are an applicable full-time employer and need to issue statements to employees and file an annual information return reporting whether and what health insurance you offered employees.

How many employees do you need for a group plan?

To be eligible for a small group health plan in most states, a company must have between two and 50 FTEs. Organizations in California, Colorado, New York, and Vermont can offer small group coverage if they have fewer than 100 employees. You can enroll in the group plan if youre the sole proprietor.

What is the minimum number of employees for group health insurance?

However, most health insurance carriers want at least two employees to sign up for a group health insurance plan. Typically, at least one of the two employees must demonstrate the reception of a W-2 form, as well as present evidence of employment.

How many employees do you need for small group health insurance?

To be eligible for small business health insurance, a company must have between one and 50 employees. That is considered a small business for purposes of purchasing group health insurance. If you have more than 50 employees, youll need to: apply for large group coverage.