Forms

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Please find some of the most commonly used forms and links to a few of the major carriers for direct access to their individual provider directories and additional resources.

Forms for Highmark Blue Cross Blue Shield

Highmark Large Group Enrollment Application

Highmark Large Group Member Change Form

Highmark Small Group Enrollment Waiver Form
Highmark Small Group Member Change Form

Forms for UPMC Health Plan

UPMC Employee Benefit Election-Change Form

UPMC Member Termination Form

Forms for Health America/Health Assurance

Health America Enrollment-Change Form

Health America Employee Termination Form

Forms for Aetna US Healthcare

Aetna Enrollment Change Form 2-50
Aetna Enrollment-Change Form 50-100

Forms for United Health Care

United Healthcare Enrollment-Change Form 2-50
United Healthcare Enrollment-Change Form 50-99

Forms for United Concordia

UCCI Enrolment Form