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Name Address 1 Address 2 City, State ZIP Date Letter mailed Client ID Dear Medicaid Member: Congratulations! You or other family members listed below have been selected for enrollment into Colorado
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How to fill out passive enrollment letter

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Step 1: Start by addressing the recipient of the passive enrollment letter. This can be the insurance company or the HR department of your organization.
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Step 2: Begin the letter by introducing yourself and providing your personal information such as your name, employee ID, and contact details.
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Step 3: Clearly state your intention to enroll in the passive enrollment program.
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Step 4: Mention any important dates or deadlines related to the enrollment process, if applicable.
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Step 5: Provide any additional information required by the insurance company or HR department. This may include details about dependents or any specific coverage preferences.
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Step 6: Express gratitude and conclude the letter by signing it with your name and the date.
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Step 7: Make a copy of the letter for your records before sending it to the designated recipient.

Who needs passive enrollment letter?

01
Employees who are currently enrolled in a different insurance plan but wish to switch to the passive enrollment option.
02
Employees who are newly eligible for insurance coverage and have not made any selections or enrollments previously.
03
Employees who have experienced a qualified life event, such as marriage or the birth of a child, that allows them to make changes to their insurance coverage.
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Passive enrollment letter is a document that automatically enrolls individuals in a program or service unless they take action to opt out.
Certain organizations or agencies may be required to file passive enrollment letters for their members or customers.
Passive enrollment letters are typically filled out by the organization or agency and sent to individuals for review and acknowledgement.
The purpose of a passive enrollment letter is to ensure that individuals are aware of their enrollment status and have the opportunity to opt out if desired.
Passive enrollment letters should include information about the program or service being offered, how to opt out, and any relevant deadlines.
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