PacifiCare
Individual Application
25/80-60/500 (PPO)
35/80-50/1000 (PPO)
70-50/3000 (SDHP)
70-50/3000 (PPO)
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.