If you want to mail a paper application for Vermont Health Connect coverage, you can download and print PDF versions of the applications below. Paper applications can take time to process, and it may be faster to apply online or call the Vermont Health Connect Customer Service Center at 1-855-899-9600. You can also make an appointment to speak with an in-person assister near you.
If you are not sure how to fill in an application, please call our Customer Service Center toll-free at 1-855-899-9600. They are available Monday – Friday from 8 am to 4:30 pm.
If you’re not sure if you can get financial help paying for coverage, the Plan Comparison Tool can help. It will also give you side-by-side plan details to help you pick the plan that’s right for you. For full details for all Vermont Health Connect plans, you can also check our plan design and rate sheet.
TO AVOID DELAYS: If you choose to fill in the paper application below and mail it to us, please make sure you have filled in every field before signing and mailing to: Vermont Health Connect, 280 State Drive, Waterbury, VT 05671-8100
Applications for Health Coverage
Individual applications (with financial help):
- Application for Health Coverage and help paying costs
- Appendix A: Assistance Completing the Application (if applicable)
- Appendix B: American Indian or Alaskan Native Family Member (if applicable)
- Appendix C: Employer Coverage Tool (if applicable)