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Health and Dental Forms

Listed below are PDF forms used to manage your account. Mail or fax the forms to the Pennsylvania Medical Society Insurance Agency.

HEALTH	VISION	SENIOR PRODUCTS	DENTAL
Highmark Blue Shield Enrollment Application Highmark Blue Shield Member Change Form Highmark Blue Shield Claim Form Highmark Blue Shield Prescription Drug Reimbursement Form Highmark Blue Shield Prescription Drug Mail Order Form Highmark Blue Shield Application for Group Benefits (2010) Highmark Blue Shield Disabled Dependent Certification Form	Davis Vision Claim Form Highmark Blue Shield Enrollment Application	Highmark Blue Shield Enrollment Application Highmark Blue Shield Member Change Form BlueRx Enrollment Form BlueRx Prescription Mail Order Form BlueRx Claim Form BlueRx Disenrollment Form Highmark Blue Shield Application for Group Benefits (2010) Highmark Blue Shield Medicare Secondary Payor Questionnaire	United Concordia Application for Group Dental Insurance United Concordia Enrollment Form United Concordia Dependent Certification Form

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Complete our online census form or call (866) 441-2392 to speak with an agent.