Dental Benefits Plan Enrollment Application Only - For enrollment period of October 1-31 of every Plan Year
Annuity Plan Membership and Other Benefits Form - For enrollment in the dental plan or other benefit plans outside of open enrollment
To obtain a member-submitted claim form or international claim form, please visit the Highmark website at www.highmarkbcbs.com or contact customer service at 866.763.9471 for assistance.
To obtain a pharmacy reimbursement form, please login to your account at www.express-scripts.com or contact customer service at 800.939.3781 for assistance.
Online Employee Retirement Contribution Agreement Form "TSA"
For current Members
Employee Retirement Contribution Agreement Form "TSA"
For new Members
Employer Compensation Change Form (formerly Salary Report Form)