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Policyholder Information


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Policyholder Contact - Secondary

Requested Implementation Date

Health Assessments start on the first of each month. Please indicate your preferred implementation start date below. Please allow three weeks lead time for program set-up.

Pinnacol Agent Information


Insurance Offered to Employees?

Additional Policyholder Information Helpful for Implementation

For example, if this is your first experience with a wellness program, your prior experience with a wellness program, your wellness program concerns, etc.

Pinnacol safety consultants will be available at Safety On Call Monday – Friday from 8 am – 5 pm at (888) 501-4752 or (303) 361-4700, or contact us via email by filling out the form below.

Please complete and submit the form below. If there is a need for your services, a representative will contact you.


Thank you for your inquiry regarding becoming an agent partner with Pinnacol Assurance. We appreciate your interest and your business.

Due to our relationship with the state as well as other factors, we have several criteria that must be met prior to applying for a full agency contract with us. Please fill out the form below in its entirety.

Are you able retain at least that same amount for the life of the relationship?
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