Rocky Mountain Health Plans

Individual Application	Solo Outlook Plan Description
Solo Outlook HSA Plan Description	Solo Outlook Active 75 and Active 10 Plan Description
Rx Options Outlook 500 to 4000 Deductible Plans	Rx Options Active 75 and 10
Rx Option HSA Plans	Employer Affidavit

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.