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With over 8 Million Dollars in new Health Premiums in 2006
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Highmark Blue Shield

Individual Medical

Application Forms

 :: HBS DirectBlue Application (revised 10-06) (pdf)
:: HBS PPOBlue Application (revised 10-06) (pdf)

Individual Medical Plan Brochures
:: Click here for Plan Brochures

Online Application Process
:: Medically Underwritten Online Application Instructions (doc)

:: Sept. Producer News Bill Me Later - Online App.doc

Miscellaneous Forms

 :: HBS, DirectBlue and PPOBlue Replacement Form (pdf)
:: Individual Products non-medical change form (pdf)
:: HBS MedicalRecords Fax CoverSheet (doc)
:: HBS DirectBlue Producer Manual (pdf)
:: HBS Pay It Easy EFT Form (pdf)
:: HIPAA Statement (pdf)

Group Medical

New Group Enrollment Forms

 :: HBS Agent of Record Letter (doc)
:: HBS Employee Enrollment Form (pdf)
:: HBS Employee Waiver Form (pdf)
:: HBS Employer Application (pdf)
:: Sold Group Checklist (doc)

Miscellaneous Forms

 :: HBS 51+ EE RFP Form (doc)
:: HBS Member Change Form (pdf)
:: Revised Underwriting and Enrollment Guidelines (doc)
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Providing Affordable High Quality Health Plans since 1961
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