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Highmark Inc. d/b/a Highmark Blue Cross Blue Shield West Virginia P. O. Box 1948 Parkersburg WV 26102 INTERNAL USE ONLY Page 9 SPECIAL ENROLLMENT PERIOD FORM A Special Enrollment Period is de ned as a time outside of the open enrollment period during which you and your family have a right to sign up for new or make changes to existing health insurance coverage. If the plan selection is between the 1st and 15th of the month your coverage will start as soon as the 1st day of the following...
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Step 1: Visit the HealthplanOne website
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Step 2: Locate the 'Send to HealthplanOne eiformr' section
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Step 3: Click on the 'eiformr' link
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Step 4: Fill out the required fields in the eiformr
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Step 5: Review the information for accuracy
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Step 6: Click on the 'Submit' button to send the eiformr to HealthplanOne

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The eiformr sent to healthplanone is a form used to report certain information about healthcare coverage.
Employers who provide self-insured health coverage are required to file the eiformr with healthplanone.
The eiformr can be filled out online through the healthplanone portal or manually by submitting a hard copy form.
The purpose of the eiformr is to provide information to the IRS about healthcare coverage provided to individuals.
Information such as the names and social security numbers of covered individuals, the months of coverage, and the employer's identification details must be reported on the eiformr.
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