Get How To Complete Your Highmark Blue Cross Blue Shield ...

Filling out the Highmark Blue Cross Blue Shield Enrollment Application is an important step in securing your health coverage. This guide provides clear instructions to help users complete the application accurately and efficiently.

Follow the steps to successfully complete your enrollment application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Start with the employee information section. Fill in your employer name and reason for application, such as 'new hire' or 'rehire'.
3. Provide your first name, middle initial, and last name in the designated fields.
4. Enter your street address, city, state, and zip code to ensure accurate processing.
5. Include your Social Security number, effective date of coverage, and state your employee status by checking the appropriate box (active, retired, hourly, or salary).
6. Fill in your home and work phone numbers, and indicate your hire date in the format required (month/day/year).
7. Select the type of coverage for which you are enrolling, whether it is for yourself, a spouse/domestic partner, or family coverage.
8. Complete items 15 through 19 with information about yourself and each eligible family member. Include their first name, middle initial, last name, Social Security number, birth date, sex, and indicate if they are students or disabled.
9. If applicable, provide information about other insurance coverage or Medicare eligibility for you or family members.
10. Complete any sections designated for your account administrator as necessary.
11. Ensure you sign and date the form where indicated to validate your application.
12. Once the form is completed, retain the last copy for your records. You can then download, print, or share the application as needed.

Complete your Highmark Blue Cross Blue Shield enrollment application online today!