RESOURCE CENTER

Installation Forms
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12.12.2012
2013 Blue Rx PDP Enrollment Kit (INDIVIDUAL)
Enrollment kit for Medicare beneficiaries looking to enroll into Highmark's Individual Blue Rx PDP. Kits contains all information needed to learn about the product, enroll, and mail back to Highmark.
email download
12.12.2012
Medigap Blue Application (INDIVIDUAL)
This form is to be completed by anyone who wishes to enroll into INDIVIDUAL Medigap Blue plan with Highmark for first time. This form should NOT be used for Individual converting from GROUP Medigap Blue.
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12.12.2012
Medigap Blue Conversion Application (INDIVIDUAL)
This form is to be completed by anyone on a GROUP Medigap Blue plan with Highmark and wishes to convert to an Individual Medigap plan. This form should NOT be used for Individual enrolling into Medigap Blue for first time.
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12.12.2012
Blue Rx - Model Short Enrollment Form (INDIVIDUAL)
Form to be completed by Medicare beneficiary to apply for Highmark's Individual Blue Rx product.
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06.01.2012
FreedomBlue PPO - 2012 Non-Group SEP application
2012 application to be completed by Medicare beneficiary to apply for Highmark's Individual FreedomBlue PPO product. This is for SEP and not AEP.
email download
06.01.2012
Blue Rx - 2012 Non-Group SEP application
2012 application to be completed by Medicare beneficiary to apply for Highmark's Individual Blue Rx product. This is for SEP and not AEP.
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