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Colorado Bulk Order Request Form

Please note that all required fields must be completed. Click on the “Submit” button to proceed to the confirmation page indicating that your order is complete.

For group specific enrollment kits, please complete the group specific enrollment kit request form.

If you are experiencing issues completing this form, please email for assistance.

* Denotes a required field.


Any orders placed after 12pm MST may be processed on the next business day. We require 7-10 business days for processing and ground shipping. If this is a RUSH request, please confirm if you are able to pick up. We are unable to overnight paper kits. Last minute requests (24-48 hour TAT) will be processed electronically only.

 Adjusted Community Rating (ACR) (1-100 Subscribers)
 Non-Adjusted Community Rating (Non-ACR) (101+ Subscribers FI, and All Savers)
 Other Collateral Item(s)

These are the standard items included in UnitedHealthcare Fully Insured kits:

  • Enrollment Form  
  • NEW! Welcome Brochure 
 UnitedHealthcare Fully Insured
 All Savers®

Please note: Effective 3-13-20 we will only be able to offer electronic enrollment kits, until further notice.

The Colorado sales office has adopted practices to achieve “social distancing” to help minimize the opportunity for contraction or spread of COVID-19. With that, we will not distribute paper kits until further notice. We appreciate your understanding.

Please contact your Field Account Manager or our kitting mailbox with any questions:


Kit Language


Delivery Information

Please provide your contact information:


Electronic kits will be delivered to above email address. If you would like us to deliver to another person, please include email address(es) in the additional spaces below.

Additional Email Addresses


If you are experiencing issues completing this form, please email for assistance.