Enrollment Tools and Forms

Click here for the Change Form.

Click here for the Change Form Spanish Version.

Click here for the Disenrollment Form.

Click here for forms for The Bancorp Bank.

Click here for the Certification of Dependent Status Form.

• SOLO
• Business Groups of One
• Small Groups
• Large Groups
• Medigap Medicare Supplement Plans

SOLO

SOLO offers the ultimate flexibility in individual and family health care coverage, giving your clients the freedom of choice they want and deserve.

SOLO offers health plans for children only, because healthy children need health care, too. Your SOLO clients can apply for health care coverage for their child (age 2 months-17) as an individual or as part of the family.

SOLO offers a variety of plan designs at competitive premiums, including HSA-eligible plans. The RMHP SOLO Sales and Administrative service team is available Monday through Friday, 8 a.m. to 5 p.m. to help you with any questions you may have on SOLO benefits, the SOLO application process, or pending SOLO application status.

Call us at 800-453-2981, Option 4. E-mail us at SOLO_Sales_Team@rmhp.org

For more information and forms you may need, click on the appropriate description.

SOLO Brochure

 SOLO Application

SOLO Application Checklist

SOLO Billing Change Form

SOLO Change Form

SOLO Plan Change Form

SOLO Preliminary Underwriting Review

SOLO Producer Underwriting Guidelines

SOLO Term Form

BUSINESS GROUPS OF ONE

If your client qualifies as a Business Group of One, you have on-line access to application and enrollment forms required to apply for coverage with RMHP. Please click on the links below to download these forms. If you need additional information or assistance, please contact your RMHP Account Executive.

Application Forms for Business Groups of One

Click on the links below to download application forms.

 Uniform Employee Application

 Uniform Employee Application Spanish Version

 Attestation Form - Business Group of One

 Open Enrollment Certification - Business Group of One

 New Group Checklist

 Request for Enrollment of Common Law Spouse

 Transition of Care

SMALL GROUPS

If your client qualifies as a Small Employer Group (2 to 50 employees), you have on-line access to application and enrollment forms required to apply for coverage with RMHP. Please click on the links below to download these forms. If you need additional information or assistance, please contact your RMHP Account Executive.

Application Forms for Small Groups

Click on the links below to download application forms.

 Small Group Enrollment Guidelines

 Uniform Employee Application

 Uniform Employee Application Spanish Version

 Application for Health Benefits - For groups with 2 or more employees

 New Group Checklist

 Group Census Request

 Request for Enrollment of Common Law Spouse

 Transition of Care

LARGE GROUPS

If you qualify as a Large Employer Group (51+ employees), you have on-line access to application and enrollment forms required to apply for coverage with RMHP. Please click on the links below to download these forms. If you need additional information or assistance, please contact your insurance agent or an RMHP Sales Office near you.

Application Forms for Large Groups

Click on the links below to download application forms.

 Large Group Proposal Request Form

 Application for Health Benefits - For groups with 2 or more employees

 Group Risk Questionnaire

 New Group Checklist

 Enrollment Form - Group Coverage

 Enrollment Form - Group Coverage - Spanish

 Individual Health Questionnaire

 Certification of Dependent Status

 Request for Enrollment of Common Law Spouse

 Transition of Care

 Employee-Dependent Waiver

Medigap plans work alongside your clients Original Medicare coverage.  Some of the benefits to you for selling our Medicap plan include:

Medigap Medicare Supplement Plans

Medigap plans work alongside your clients Original Medicare coverage. Some of the benefits to you for selling our Medigap plan include:
 

• You get choice – the right plans (A, C, F and G) at the right price; choices your clients deserve.
   
• You get customer service – located right here in Colorado, RMHP has local operations dedicated to high-quality benefit administration and customer service.
   
• You get peace of mind – backed by a strong and stable company with an established reputation and more than 30 years of experience serving Coloradans.
• RMHP Medigap plans are available for people with Medicare, regardless of their age.
   

Call us for more information at 888-334-7886.
 

For more information and forms you may need, click on the appropriate description.
 

Medigap Application
 

Medigap Application Checklist
 

Medigap Underwriting Guidelines 
 

Plan Comparison Chart
 

Plan Rates
 

    Plan A 
 

    Plan C 
 

    Plan F 
 

    Plan G 
 

Outline of Coverage