To apply for ADA MedCASH coverage, simply download and print this application. Your completed application can be faxed to Great-West Life at 303-737-4843 or mailed to us at P.O. Box 340, Denver CO 80201. If you have questions while completing your application, contact Great-West Life at 866-607-5338 or ada@gwl.com.
When you click on the button below, please be patient while the application is retrieved. Because the file is large, it may take several minutes to download.
Application
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