UPDATED SPECIAL ENROLLMENT PERIOD FORM

Enrollment outside of the open enrollment period due to a qualifying life event, known as a Special Enrollment Period (SEP), is now available through the Producer Portal, and is required to be submitted via paper application (secure email, fax or mail).

The SEP form has been updated to provide more comprehensive information.  For your convenience, this form has been posted on the Producer Portal under the Resources section.  Please begin to use the new SEP form immediately and discard any prior forms you have.    

Highmark will only accept the receipt of a completed SEP form, along with a completed application and supporting documentation. Failure to provide these required materials may delay your requested coverage effective date or cause your customer to be denied coverage. The effective date of coverage will be determined by the receipt date of completed information as specified above. The coverage effective date cannot be prior to the occurrence of the event. Applications received outside of the required SEP time frame for the specified qualifying life event will be denied.

If you have any questions, please contact your Highmark Individual Sales Channel Consultant.