Humana One

Application	Enhanced Copay 80% Plan Description
Copay 80% Plan Description	Copay 70% Plan Description
Value 100% Plan Description	Enhanced H.S.A. 100% Plan Description
H.S.A. 100% Plan Description	Short-Term Application
Dental/Vision Application

Forms can be faxed to our office at (303) 721-1085. Please confirm that application was received by calling (303) 721-1145. Please call with any questions regarding eligibility or waiting periods.