Get the free highmark member change form

Page 2 Membership Department P. O. Box 890172 Camp Hill PA 17089 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 Single Parent/Child I...

How to fill out highmark member change form

How to fill out highmark member change form:

1. Obtain a copy of the highmark member change form from the highmark website or by contacting their customer service.
2. Fill out your personal information section accurately, including your name, address, contact information, and highmark member identification number.
3. Provide the effective date of the change you are requesting, such as the start date for a new coverage plan or the termination date of an existing plan.
4. Indicate the reason for the change, whether it is due to a life event, job change, or other circumstances.
5. If you are adding or removing dependents from your coverage, include their names, birthdates, and relationship to you.
6. Include any additional information or documentation required by highmark, such as proof of a qualifying event or legal documentation for dependents.
7. Review the completed form thoroughly to ensure all information is accurate and legible.
8. Sign and date the form before submitting it to highmark by mail, fax, or electronically through their designated online portal.

Who needs highmark member change form:

1. Individuals who are currently highmark members and need to make changes to their coverage plan.
2. Highmark members who have experienced a qualifying life event, such as marriage, birth, adoption, divorce, or loss of employment.
3. Employers or HR representatives who manage highmark coverage for their employees and need to update information for individuals or dependents.

For pdfFiller’s FAQs

How do I edit highmark member change form in Chrome?

Download and install the pdfFiller Google Chrome Extension to your browser to edit, fill out, and eSign your highmark member change form, which you can open in the editor with a single click from a Google search page. Fillable documents may be executed from any internet-connected device without leaving Chrome.

How do I fill out highmark member change form using my mobile device?

Use the pdfFiller mobile app to fill out and sign highmark member change form on your phone or tablet. Visit our website to learn more about our mobile apps, how they work, and how to get started.

How do I edit highmark member change form on an iOS device?

Yes, you can. With the pdfFiller mobile app, you can instantly edit, share, and sign highmark member change form on your iOS device. Get it at the Apple Store and install it in seconds. The application is free, but you will have to create an account to purchase a subscription or activate a free trial.

What is highmark member change form?

The highmark member change form is a document used to request changes to a member's information in the highmark system.

Who is required to file highmark member change form?

Any highmark member who needs to update or change their information in the highmark system is required to file the highmark member change form.

How to fill out highmark member change form?

To fill out the highmark member change form, you need to provide your current information in the required fields and indicate the changes you want to make. The form can be filled out electronically or manually.

What is the purpose of highmark member change form?

The purpose of the highmark member change form is to allow highmark members to update or change their information in the highmark system, ensuring that accurate and up-to-date information is maintained.

What information must be reported on highmark member change form?

The highmark member change form requires you to report your current information such as name, address, contact details, and any other relevant information that needs to be updated or changed.