APPLICATION FOR NEW 2019 INDIVIDUAL - Preview on Page 1

APPLICATION FOR NEW 2019 INDIVIDUAL --2026

The document is an application form for new individual or family health insurance coverage through Highmark for the year 2019. It outlines the steps required to complete the application, including providing personal information, selecting a health insurance plan based on county, detailing any existing health insurance, and specifying communication preferences. The document emphasizes the importance of completing all sections accurately to avoid delays in processing and includes instructions for submitting the application and payment.

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Click ‘Get Form’ to open the APPLICATION FOR NEW 2019 INDIVIDUAL in our editor.
Begin with STEP 1 by providing your personal information. Fill in your first name, last name, date of birth, and contact details clearly. Ensure all fields are completed to avoid delays.
Move to STEP 2 where you will select your health insurance plan based on your county. Review the options carefully and mark your choice with an 'X'.
In STEP 3, disclose any other health insurance coverage you may have. This is crucial for processing your application efficiently.
Proceed to STEP 4 to choose how you would like to receive communications regarding your coverage—either electronically or via paper.
Finally, in STEP 5, sign the application and submit it along with your first month's premium payment. You can do this online through our platform for a faster process.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (32 Votes)
2017	4 Satisfied (25 Votes)

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