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Forms

Forms

Listed below are forms for you to complete. When you select a form an instruction page will appear. Mail or fax the forms to the Pennsylvania Medical Society Insurance Agency.

Highmark Blue Shield Enrollment Application  
Highmark Blue Shield Member Change Form  
Highmark Blue Shield Claim Form  
United Concordia Application for Group Dental Insurance  
United Concordia Enrollment Form  

For more information call (866) 441-2392 or use the online information request form.