Highmark ENR-163 2013 free printable template
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For Changes Highmark Health Insurance Company P. O. Box 890172 Camp Hill PA 17089-0172 MEMBER CHANGE FORM COMPLETE THIS APPLICATION IN ITS ENTIRETY IN BLUE OR BLACK INK. DO NOT USE PENCIL OR HIGHLIGHTER* APPLICANT INFORMATION Effective Date Employer Name REASON FOR COMPLETION q Changes q Act 4 Dependent q Cancel q COBRA/mini-COBRA Start Date End Date CANCEL/COBRA REASON q Deceased q Left Employment Group Number OTHER CHANGES q New Name q New Address q Change to Medicare Eligible q Change...
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How to fill out Highmark ENR-163
How to fill out Highmark ENR-163
01
Obtain the Highmark ENR-163 form from the Highmark website or your local Highmark office.
02
Fill in the member's personal information including name, address, and date of birth in the designated fields.
03
Provide the member's Highmark identification number accurately.
04
Specify the plan type by selecting the appropriate option from the drop-down menu.
05
Complete the reason for enrollment section, detailing what prompted the enrollment.
06
Include any necessary additional information or documentation as required by Highmark.
07
Review the completed form for accuracy to ensure all fields are filled correctly.
08
Sign and date the form at the bottom where indicated.
09
Submit the form via mail or fax to the appropriate Highmark department as instructed.
Who needs Highmark ENR-163?
01
Individuals looking to enroll in a Highmark health insurance plan.
02
Current members who are making changes to their existing coverage.
03
Dependents or family members requiring health insurance under Highmark plans.
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People Also Ask about
How do I contact Highmark BCBS Delaware?
Call 1-866-488-7469 TTY: 711 (Monday - Sunday 8:00am to 8:00pm EST) to talk to a representative who can answer questions about our plans.
What is the phone number for BCBS PA Highmark Blue Shield provider?
Provider Service Center at: Western Region: 1-800-547-3627, option 2. Central Region: 1-800-345-3805, option 3. Hours are from 9:00 a.m. to 4:30 p.m., Monday through Friday.
What is timely filing for Highmark BCBS of Delaware?
All claims including EPSDT claims must be received within 120 days of the date of service or 60 days from the date of remittance from a primary payer.
How do I recover my Highmark online access?
Please call the help desk at 1-877-298-3918 to retrieve your username or password.
What is the phone number for Highmark bcbs pa provider credentialing?
Request a Call to talk to a Highmark licensed representative about our non-Medicare plans or to enroll. Not a Highmark member? Call 1-866-488-7469 TTY: 711 (Monday - Sunday 8:00am to 8:00pm EST) to talk to a representative who can answer questions about our plans.
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What is Highmark ENR-163?
Highmark ENR-163 is a form used for reporting certain employee-related information to Highmark, specifically related to health insurance and benefits.
Who is required to file Highmark ENR-163?
Employers and organizations that provide health insurance coverage through Highmark are required to file Highmark ENR-163 for their employees.
How to fill out Highmark ENR-163?
To fill out Highmark ENR-163, gather necessary employee information such as names, social security numbers, and details about the coverage. Complete all required fields accurately and ensure all supporting documents are included.
What is the purpose of Highmark ENR-163?
The purpose of Highmark ENR-163 is to collect data relevant to employee health coverage to ensure compliance with health insurance regulations and to facilitate proper management of health benefits.
What information must be reported on Highmark ENR-163?
The information that must be reported on Highmark ENR-163 includes employee personal details, insurance coverage details, dependent information, and any applicable changes to coverage.
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