Documents & Enrollment
Forms
UPMC Health Plan
Employee Benefit Election & Change Form
For ACA-compliant groups with 1–50 employees. Use for enrollment, plan changes, or cancellations.
Membership Termination Form
Use to terminate employees from your group medical, dental, or vision plan.
Highmark
Enrollment / Waiver Form
For new enrollments, qualifying life events, or to formally waive coverage for yourself or dependents.
Member Change Form
Use for dependent changes, address updates, cancellations, and Medicare coordination.
2026 Small Group Product Portfolio
Full plan overview for groups with 50 or fewer employees in the Western Pennsylvania region. Effective January 1, 2026.
2026 Large Group Combined Portfolio
Comprehensive plan guide for groups with more than 50 employees in the Western Pennsylvania region. Effective January 1, 2026.
Principal
Create Your Principal Account
Access your benefits, view claims, find network providers, and manage coverage anytime — online or through the free Principal app.
PDP Medicines Form
PDP Medicines Form
Complete this online form to submit your prescription drug information for a Part D plan review.
Scope of Appointment (SOA)
Federal law requires a completed Scope of Appointment form before we can discuss any Medicare Advantage, Part D, or Medigap plans with you. Please download the form, complete it, and email it directly to our team before your appointment.
Forms available here may be used to enroll; however, we are not responsible for submissions that are not completed or verified through one of our licensed benefits specialists. There are often faster and more efficient ways to enroll — we encourage you to contact one of our specialists to ensure your enrollment is handled properly.
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