To apply for HIPUtah coverage, you must follow these steps
- Print out the HIPUtah Application and complete it in ink (online submission is not yet available). Please pay special attention to the instructions and provide the necessary information requested. If the application is not complete or if the required documentation is missing, the application will be returned to you and will delay the application process and your effective date
HIPUtah Application - Include copies of your medical records or a physician's letter detailing your diagnoses and prognoses with your application. In addition, to receive credit for prior insurance coverage, you must submit proof of previous insurance.
- Choose a deductible and premium. There are four calendar year deductible options available. The HIPUtah Outline of Coverage includes information on these. Choose the specific deductible desired and determine the monthly rate (premiums) for the deductible you have selected
HIPUtah Outline of Coverage
HIPUtah Premiums - Select one of the payment options on the HIPUtah Payment Selection Form
HIPUtah Payment Selection Form - When all forms are completed, mail the application, the medical information, proof of insurance, and payment option to the following address:
HIPUtah
c/o SelectHealth
P.O. Box 30192
Salt Lake City, Utah 84130-0192
If the application is complete and all documentation is provided, you can expect to receive a status report from a HIPUtah representative within two weeks of the submission of your application. If additional medical information or other information is required, we will contact you.
For more information, or if you have questions about the application process, please call HIPUtah's Administrator, SelectHealth, at 801-442-6660 (Salt Lake area) or 800-705-9173.
