If you wish to apply, choose your plan and follow these easy steps:

1. Email us for an application.

2. Enter your credit card number on the last page of the application or write "Bill Me Later" on that page. Your credit card will be charged the first      monthly premium upon receipt of your application. Highmark will return a full refund should you be turned down for coverage.

3. View the reminder checklist.

4. Print, complete and return the Replacement form if you are replacing your present insurance coverage.

5. Please fax or return your completed application to:

ATTN: Highmark Individual Insurance
Application Processing Center
PMB 373
256 Eagleview Blvd Ste 200
Exton, PA 19341-9977

Fax: 866-374-7569

Please Note:
Receipt of your initial payment does not constitute enrollment under this program. Your coverage will not begin until this application has been accepted by Highmark Blue Shield and you have been notified that an effective date of coverage has been assigned. If your application is approved by the medical underwriting department on or before the 27th day of the month, your coverage will become effective on the first day of the following month. Failure to provide all the information requested may result in a delay in the processing of your application.