Highmark BCBS Form ENR-010 2009 free printable template

ENR-010 R2-09 Membership Department P. O. Box 535193 Pittsburgh PA 15253-5193 In order to process this Change Form the name and Member Identification Number of the Employee/Contract Holder must be completed in the space provided. Employer Telephone Number First Employee Last M. I. COMPLETE ONLY THE SECTIONS THAT APPLY TO CHANGES IN MEMBER RECORDS. Street Address City Hire Date Group No. State Report Code Zip Code Home Phone Work Phone I Single I ...

How to fill out Highmark BCBS Form ENR-010

How to fill out Highmark BCBS Form ENR-010

1. Gather necessary information: Collect personal details such as member ID, name, address, and contact information.
2. Obtain the form: Download or request Highmark BCBS Form ENR-010 from the official Highmark website or your local insurance representative.
3. Complete the form: Fill in all required fields accurately, ensuring that personal and insurance information is correct.
4. Include additional information: If applicable, provide details about dependents or other relevant information that may be needed.
5. Review the form: Verify that all sections are completed and that there are no errors or omissions.
6. Sign and date: Ensure that the form is signed and dated in the designated areas to confirm authenticity.
7. Submit the form: Send the completed form through mail or online, following any specific submission instructions provided.

Who needs Highmark BCBS Form ENR-010?

1. Individuals who are members of Highmark BCBS and are seeking to update or enroll in health insurance coverage.
2. New members looking to register and provide necessary personal and demographic information.
3. Existing members who need to report changes in their personal information or dependents.

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What is Highmark BCBS Form ENR-010?

Highmark BCBS Form ENR-010 is a specific enrollment form used by members of Highmark Blue Cross Blue Shield to provide necessary information for their health insurance coverage.

Who is required to file Highmark BCBS Form ENR-010?

Individuals who are enrolling for the first time in a health insurance plan with Highmark BCBS or those making changes to their existing enrollment are required to file Highmark BCBS Form ENR-010.

How to fill out Highmark BCBS Form ENR-010?

To fill out Highmark BCBS Form ENR-010, individuals must provide personal information, including their name, identification number, contact details, and any changes to dependents or coverage plans, ensuring all sections are completed accurately.

What is the purpose of Highmark BCBS Form ENR-010?

The purpose of Highmark BCBS Form ENR-010 is to facilitate the accurate enrollment of members in health insurance plans and to ensure that the necessary personal and health information is collected for processing.

What information must be reported on Highmark BCBS Form ENR-010?

The information that must be reported on Highmark BCBS Form ENR-010 includes personal identification details, contact information, dependent information, coverage selection, and any relevant health history as required by the insurance provider.