Product portfolios and brochures

Product Portfolios

    2024

• 2024 ACA Small Group Product Portfolio

Network Maps

• 2024 SG ACA Network Map Brochure

Additional Brochures

    2024

• 2024 Small Group Pediatric Dental and Vision Brochure
• Highmark Value Prop & Living Health Flyer
• 2024 Preventive Schedule

Applications, Waivers, Affidavits

• 2024 HRA Application
• HSA Application
• Small Group Business Application (2024)
• Enrollment/Waiver Form (2024)
• Start-Up Business Affidavit
• Disability Verification Form
• Disabled Dependent Certification
• Affidavit of Common Law Marriage
• Act 4 Dependent Verification Form
• Domestic Partner Affidavit
• New Employee Affidavit
• Certification of Eligibility to Combine and Employer Group Size

Other Forms and Checklists

• Small Group Sold Checklist
• Underwriting Guidelines
• Enrollment Spreadsheet
• Member Change Form
• Authorization to Cancel Highmark Small Business Coverage
• General Update Changes for Small Group
• Client Change Letter of Explanation (Template) Checklist
• Regional Small Group New Business Submission Guide

Additional Resources

• 2024 Quarter 1 Rates for Southeastern Pennsylvania
• 2024 Quarter 2 Rates for Southeastern Pennsylvania
• 2024 Quarter 3 Rates for Southeastern Pennsylvania
• Small Group Client Admin Guide
• Employer HSA Contribution and Funding Guide
• Member HSA Guide