Applying online is as simple as completing the requested information and submitting it to us through our secure Web site.
To complete the application, you need a recent version of Adobe Acrobat Reader®.
Complete and save the HIPUtah or Federal-HIPUtah application.
If you have questions, please call 801-442-6660 (Salt Lake Area) or 800-705-9173.
Complete the fields below. Use the "Browse" button to attach your saved application and supporting documentation (HIPUtah and Federal-HIPUtah Applicants must include medical records or physician letter showing diagnosis). Click "Apply Now" when finished.