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Get Highmark Enrollment Waiver Form
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How to fill out the Highmark Enrollment Waiver Form online
Filling out the Highmark Enrollment Waiver Form online can be a straightforward process if you understand each section of the form. This guide provides clear, step-by-step instructions to help you navigate the form with confidence.
Follow the steps to complete your form successfully.
- Press the ‘Get Form’ button to access the Highmark Enrollment Waiver Form online and open it in your preferred editor.
- In the top right corner, enter the Product Name you are enrolling under. Next, select the Type of Coverage you and your eligible dependents have chosen (e.g., employee only, two person, etc.).
- Complete Section I, titled Employee/Applicant Information. This section is mandatory and should include the Effective Date of Coverage, your Employer Name, your Group Number (if applicable), and your personal details such as name, address, and phone number.
- In Section II, Covered Dependent Enrollment/Change Information, provide details about each eligible dependent. Ensure you indicate the relationship to the employee, using the codes provided for any non-standard relationships like Domestic Partner or Other.
- If you or your family members have other insurance, respond ‘yes’ or ‘no’ to the related question in Section II. For any dependent who is a student over 19, disabled, or eligible under Act 4, check the appropriate box.
- Move to Section III for Waiver Information. This section is required only if you wish to decline coverage for yourself and/or your dependents. Provide the reason for waiving coverage and ensure to sign the section.
- In Section IV, About Your Other Group or Non-Group Health Insurance Coverage and Medicare, complete the details regarding any other insurance coverage each enrollee has if you answered 'yes' previously.
- Complete Section V, the Authorized Signatures section. Your signature and the employer’s signature are both necessary for the form to be valid, along with the date.
- Review all entered information for accuracy. Once confirmed, you can save the form, download it, print it for your records, or share it as needed.
Get started on filling out the Highmark Enrollment Waiver Form online today!
Yes, an employee can waive health insurance offered by their employer. However, this usually requires completing the Highmark Enrollment Waiver Form to document that you are choosing not to enroll. Be sure to understand the potential impacts on your health coverage and any future options you may have. Reviewing your choices with HR can help clarify any uncertainties you may have.