Get Highmark Bcbs Form Enr-010 2014-2025

Filling out the Highmark BCBS Form ENR-010 online can be a straightforward process if you have the right guidance. This form is essential for updating your membership information with Highmark Blue Cross Blue Shield, and it is designed to accommodate various changes in your records.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the Highmark BCBS Form ENR-010. This will enable you to open and start filling out the form online.
2. Enter the employer's name in the designated box at the top of the form. This identifies the organization associated with your health coverage.
3. Provide the employer’s telephone number. This is necessary for any follow-up communications regarding your change request.
4. Input the unique 8-digit group number assigned to your employer's health insurance plan. This helps in identifying your specific insurance group.
5. Fill in the Employee's last name, first name, and middle initial accurately, as this identifies you as the primary member.
6. Indicate the effective date of the changes requested on this form. This date marks when the requested changes will take effect.
7. Utilize the provided space to describe the changes you wish to make. Be clear and concise to ensure that your intentions are understood.
8. Complete the street address, city, state, and zip code sections. Make sure these details are current to guarantee accurate correspondence.
9. Fill in the applicable phone numbers — both home and work — as this helps Highmark contact you if needed.
10. Check the appropriate box under the type of change you are requesting: Add, Termination, or Change. Be sure to provide reasons where applicable.
11. For any updates regarding your dependents, spouse, or domestic partner, ensure that all relevant fields are filled out with the correct changes.
12. Complete the current and previous identification numbers to track your records through the transition.
13. If applicable, fill in any information about other insurance coverage you, your spouse, or any dependents may have.
14. Both the employee and employer must sign and date the form at the specified areas to validate the changes.
15. Once you have reviewed all entries for accuracy, save your changes, and download, print, or share the completed form as needed.

Start filling out your Highmark BCBS Form ENR-010 online today to ensure your information is up to date.