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RMHP: Rocky Mountain Health Plans



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Commonly Used Forms

 

By downloading our Employer Group Manual or the Business Group of One Manual, you can reference administrative procedures relating to enrollment and disenrollment requirements, continuation of coverage requirements, and premium billing explanations.
 
In addition to these manuals, you can also download commonly used forms for each group listed below:

 

 

Service-related Forms for All Employer Groups

 
Authorization for Release of Information
Disenrollment Form
Change Form
Change Form - Spanish
Notice of Qualifying Event Form COBRA/CCOC
Electronic Funds Transfer for Employer Groups
Request for Enrollment of Common Law Spouse
Request for Enrollment of a Disabled Dependent
COBRA TEA Letter

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Business Groups of One

 
If you qualify as a Business Group of One, you can download the application and enrollment forms required to apply for coverage with RMHP below. If you need additional information or help, please contact your insurance agent or an RMHP Sales Office you.
 
Uniform Employee Application
Uniform Employee Application - Spanish Version
Attestation - Business Group of One
Open Enrollment Certification - Business Group of One
New Group Checklist

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Small Groups

 
If you qualify as a Small Employer Group (2 to 50 employees), you can download the application and enrollment forms required to apply for coverage with RMHP below. If you need additional information or help, please contact your insurance agent or an RMHP Sales Office you.
 
Uniform Employee Application
Uniform Employee Application - Spanish Version
New Group Checklist
Application for Health Benefits - For groups with 2 or more employees

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Large Groups

 
If you qualify as a Large Employer Group (51+ employees), you can download the application and enrollment forms required to apply for coverage with RMHP below. If you need additional information or help, please contact your insurance agent or an RMHP Sales Office you.
 
Enrollment Form - Group Coverage
Enrollment Form - Group Coverage - Spanish
Employee-Dependent Waiver
New Group Checklist

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Rocky Mountain Health Plans