The Xcel Energy medical certification form lets a household pause shutoffs, late fees, and disconnection notices for 90 days when someone living at the service address has a medical condition that would be endangered by losing power or gas. A completed form will also restore service that has already been cut off. To be valid, the form must be signed by an MD, physician assistant, or nurse practitioner, and you can use the 90-day protection once every 12 months.1Xcel Energy. Medical Assistance Programs – Billing and Payment
Where to Download the Right Form
Xcel posts the medical certification form as a PDF on the Medical Assistance Programs page for each state it serves: Colorado, Michigan, Minnesota, New Mexico, North Dakota, South Dakota, Texas, and Wisconsin.2Xcel Energy. Service Areas – Energy Sources and Delivery Each state has its own version with slightly different rules, so download the one for your state. A Spanish version is available for Colorado customers.1Xcel Energy. Medical Assistance Programs – Billing and Payment If you can’t print, call Xcel customer service and ask for a paper copy by mail.
Who Qualifies
The protection covers any residential customer whose household includes a permanent resident whose medical condition would worsen or become an emergency if utility service were cut off. Colorado’s Rule 3407 sets the standard: a licensed medical professional must certify that disconnecting service would “aggravate an existing medical emergency or create a medical emergency” for the customer or a permanent resident.3Colorado Secretary of State. Colorado Department of Regulatory Agencies – Public Utilities Commission Rules New Mexico’s form uses similar language, covering conditions where a loss of service would create “substantial risk of death or gravely impair health.”4Xcel Energy. New Mexico Financial and Medical Certification Form
The patient must live at the service address full time, not visit occasionally. The form does not require you to list specific devices like oxygen concentrators or ventilators; it asks the provider to certify the health risk. If the patient does rely on powered medical equipment, noting it on the form strengthens the request.
Filling Out the Customer Section
You, as the account holder, complete the first part. You’ll need:
- Your Xcel Energy account number, which appears on any recent bill
- The patient’s full legal name
- The service address exactly as it appears on the bill
- A working phone number where Xcel can reach you
If the patient is not the account holder, use the account holder’s number and enter the patient’s name in the patient field.5Xcel Energy. Colorado 90-Day Medical Certification Form
Filling Out the Medical Provider Section
The medical section must be completed by a medical doctor (MD), physician assistant (PA), or nurse practitioner (NP). No other provider type qualifies. The provider certifies that terminating electric or gas service would aggravate an existing condition or create a medical emergency for the named patient, and supplies name, phone number, state license number, and signature. Without that signature, the form is not valid.5Xcel Energy. Colorado 90-Day Medical Certification Form
Under Colorado Rule 3407, Xcel cannot challenge the provider’s clinical judgment. The utility can only verify that the certification is authentic, such as confirming the license number and that the signature came from the provider’s office.3Colorado Secretary of State. Colorado Department of Regulatory Agencies – Public Utilities Commission Rules
If a disconnection is imminent and you can’t get the paperwork signed in time, Colorado rules let the medical provider’s office notify Xcel by phone first. A written certificate must follow within ten days.3Colorado Secretary of State. Colorado Department of Regulatory Agencies – Public Utilities Commission Rules Ask your doctor’s office to call while you work on the paperwork.
How to Submit the Form
Once the provider has signed, send the completed form to Xcel by one of these methods:
- Fax: 612-564-7626
- Email: PAR@xcelenergy.com
- Mail: Xcel Energy, Attn: PAR Department, 1800 Larimer St., Denver, CO 80202
Email or fax is faster than mail, which matters if a shutoff is scheduled soon.6Xcel Energy. 90-Day Medical Certificate Before you send, confirm every field is filled in, the signature is present, and the license number is legible. Incomplete forms are the most common reason for rejection, and resubmitting burns time you may not have.
What Happens After Xcel Receives the Form
Once Xcel has a completed and signed certificate, it suspends shutoff action for 90 days and pauses late fees and disconnection notices on your account.1Xcel Energy. Medical Assistance Programs – Billing and Payment If your service was already disconnected, Xcel will restore it on receipt of the certificate.5Xcel Energy. Colorado 90-Day Medical Certification Form
The protection stops the shutoff; it does not pause the bill. Monthly charges keep accruing and any past-due balance stays on the account. Xcel directs certification customers to its energy assistance page to set up a payment arrangement or apply for programs like Colorado’s Low-Income Energy Assistance Program (LEAP) during the 90-day window.1Xcel Energy. Medical Assistance Programs – Billing and Payment Those programs take time to process, so apply early.
Under Rule 3407, Xcel cannot demand payment as a condition of honoring the certificate itself. If you had a prior payment arrangement that you broke before seeking certification, Xcel may require you to pay the amounts that were due as of the original certificate date before setting up a new installment plan.3Colorado Secretary of State. Colorado Department of Regulatory Agencies – Public Utilities Commission Rules
Renewal, Extended Certification, and State Differences
The standard 90-day certificate can be submitted once every 12 months. When the 90 days end, your account returns to normal collection status, and Xcel can resume disconnection procedures for any unpaid balance.1Xcel Energy. Medical Assistance Programs – Billing and Payment Track the expiration date so a shutoff notice doesn’t catch you off guard.
Some states offer an extended certification. In New Mexico, if the provider certifies that the patient’s condition is permanent and will not improve within 12 months, the extended certification can suspend disconnection for up to one year, though you must recertify your financial situation every 90 days by resubmitting the required sections.4Xcel Energy. New Mexico Financial and Medical Certification Form
Rules vary by state. Michigan’s medical certification suspends shutoff for at least 21 days rather than 90, and Xcel may charge a deposit to restore service that was disconnected for nonpayment.7Xcel Energy. Michigan Medical Certification – Billing and Payment Read the instructions on your state’s form.
The certificate is tied to a specific person at a specific address and does not transfer. If the patient recovers, moves, or changes treating providers, tell Xcel and submit an updated form with the new provider’s license number and signature.