Highmark ENR-163 2016 free printable template
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MEMBER CHANGE FORM COMPLETE THIS APPLICATION IN ITS ENTIRETY IN BLUE OR BLACK INK. DO NOT USE PENCIL OR HIGHLIGHTER.EMPLOYEE/CONTRACT HOLDER INFORMATION Effective DateEmployer/Group NameREASON FOR
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How to fill out Highmark ENR-163
How to fill out Highmark ENR-163
01
Begin by gathering all necessary personal and insurance information.
02
Fill out the subscriber's information section with the name, address, and date of birth.
03
Provide the insurance policy number and group number under the relevant sections.
04
Complete the dependent information by listing any covered family members, including their names and relationship to the subscriber.
05
Indicate the type of coverage desired (e.g., medical, dental, vision) and any specific plan selections.
06
Review the completed form for accuracy and completeness.
07
Sign and date the form at the bottom, as required.
08
Submit the form according to the provided instructions, either online, via mail, or fax.
Who needs Highmark ENR-163?
01
Individuals who are looking to enroll in or update their Highmark health insurance coverage.
02
Employees seeking to add dependent coverage or change their existing plan.
03
New members who have recently acquired health insurance through Highmark.
04
Current policyholders needing to make changes to their personal information or coverage options.
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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 specific form used for reporting information related to employee health insurance coverage and enrollment under Highmark health plans.
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 enrolled employees.
How to fill out Highmark ENR-163?
To fill out Highmark ENR-163, follow the provided instructions on the form, ensuring all required fields are accurately completed with the relevant employee and coverage details.
What is the purpose of Highmark ENR-163?
The purpose of Highmark ENR-163 is to facilitate the reporting and tracking of health insurance enrollment information between employers and Highmark.
What information must be reported on Highmark ENR-163?
The information that must be reported on Highmark ENR-163 includes employee details, coverage selection, effective dates, and any changes in enrollment status.
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