2017 SMALL GROUP FILLABLE PDFS NOW AVAILABLE

Fillable PDF versions of the 2017 Enrollment/Waiver and Member Change forms are now available on the Producer Portal under the Resources section for all regions.

If you have any questions, please contact your Highmark Client Manager or Sales Executive.

This email and any attachments contain important information about Highmark, including its products, customers and business
processes, and may include information which Highmark considers to be confidential and proprietary ("the Highmark Information").
The Highmark Information is intended solely for the use of the individual or entity to which it is addressed, including employees of that
entity with a need to access such information. Unauthorized use, disclosure or copying of the Highmark Information, including the
posting of such information on a website or social media sites that can be accessed by third parties, is strictly prohibited.

® Highmark is a registered mark of Highmark Inc.

120 Fifth Avenue Pittsburgh, PA 15222 USA