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A form to request reimbursement for out of pocket payment of prescription drugs
A list of Special Enrollment reasons and verification documents
A form to allow Mountain Health CO-OP to release information to someone else
A form to authorize monthly payments
A form to report changes to off exchange coverage
If you are a Marketplace, or Healthcare.gov member, please call 1.800.318.2596 to update your address or household information
For group changes, please talk to your HR department.
Information on your appeal rights.
Click to go to an online form to file an appeal.
Direct application only, NOT marketplace applications