Installation Forms
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Employer Application (for new & renewal - eff 1/2014)
Highmark branded installation form to be completed by employer for new 2-50 eligible business, for new business or renewal business as of 1/2014 effective dates. Old apps will not be accepted.
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2013 Submission Deadlines
Horizon releases their submission deadlines for 2013. As a reminder retention changes must be submitted by the 8th prior to anniversary, if not, the next available effective date will be assigned.
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Enrollment/Waiver Form
Employee enrollment form to be used by an NEW Highmark member, in order to elect/waive Highmark coverage. This is not intended to be used by existing Highmark members to add/change dependents, start/end COBRA, or terminate coverage.
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Group HSA Application
Group Health Savings Account (HSA) Application must be used for clients with 50 or less contracts electing to enroll in Highmark's Health Savings Account with Bank of America.
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