Access your member forms and documents quickly when you need them.
Use these forms when you’re ready to become a D-SNP member.
Highmark Health Options Duals – 2026 Enrollment Form - English
Highmark Health Options Duals – Solicitud de inscripción a Medicare D-SNP 2026 - Espanol
Appointment of Representative Form (CMS Form-1696)
Disaster or Emergency Information
Medicare Complaint Form
Request for Drug Coverage Form
Request for Medicare Prescription Drug Coverage Determination Instructions
Request for Medicare Prescription Drug Coverage Determination Form
Standard Redetermination Request Form
