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Colorado Prescreening Questionnaire

Effective January 1, 2012, all carriers issuing individual health benefit plans in the state of Colorado, are required to make available a prescreening questionnaire. If you have a pre-existing medical condition, and suspect you may not be eligible for individual coverage, prior to submitting an application for insurance, you may complete the prescreening questionnaire and submit it to the insurance carrier of your choice. The carrier may decide to issue coverage, ask you for additional information, or decide to deny coverage. If the carrier decides to deny coverage based on your answers to the prescreening questionnaire, that denial may serve as your CoverColorado medical eligibility form. CoverColorado provides health insurance to individuals with pre-existing medical conditions. For information on CoverColorado, please contact an enrollment specialist at the CoverColorado Administration Office at 303-863-1960 or 1-866-787-9129 (8 am – 5 pm MST, M-F), or at: CoverColorado, 425 South Cherry Street, Suite 160, Glendale, CO 80246, or visit the website www.covercolorado.org.

A copy of the prescreening questionnaire is available here.

  • If you answer "Yes" to any question, and wish to submit the prescreening questionnaire to Humana, you may fax it to Attn: CO Prescreen at 1-920-339-7723, or mail to Humana, Inc., Attn: Underwriting – CO Prescreen, PO Box 1633, Waukesha, WI 53187. A decision will be made and communicated within 5 to 7 business days. Alternatively, you may submit directly to CoverColorado, a letter on your doctor's letterhead (or prescription form) reflecting your doctor's name, address, and phone number. The letter must state your name and exact diagnosis, and must be signed and dated by your doctor and must accompany your CoverColorado application. In this case the prescreen questionnaire and denial letter from a private health insurance carrier is not necessary.
  • If you have not answered "Yes" to any question in the questionnaire, do not submit the prescreening questionnaire. You may complete a full application for insurance to the insurance carrier of your choice.

For more information and a CoverColorado application, please visit the website www.covercolorado.org.

Insured by Humana Insurance Company, Humana Health Plan, Inc., Humana Health Insurance Company of Florida, Inc., Humana Health Benefit Plan of Louisiana, Inc., HumanaDental Insurance Company, or The Dental Concern, Inc.,or offered by Humana Employers Health Plan of Georgia,Inc.,or Humana Medical Plan,Inc.

For Arizona residents: Insured by Humana Insurance Company or HumanaDental Insurance Company. For Texas residents: Insured by Humana Insurance Company or HumanaDental Insurance Company or DentiCare Inc. For Mississippi residents: Insured by Humana Insurance Company or HumanaDental Insurance Company or CompBenefits Insurance Company.