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  • Highmark Bcbs Form Enr-010 2014

Get Highmark Bcbs Form Enr-010 2014-2025

Social Security number of the covered individual. 4) Group Number - Unique 8 digit identification number assigned to the group. 16) Previous Last Name - The last name of the covered individual prior to the change. 5) Employee - The employee s last name, first name and middle initial. 17) Current Last Name - The last name of the covered individual. 1) Employer Name - The employer s name. 6) Member Identification Number - The member s Social Security Number. 7) Effective Date - The ef.

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How to fill out the Highmark BCBS Form ENR-010 online

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.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232