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Change of Address From

Moving? Simply complete the form below to change your address.

Last Name:
First Name, MI: , 

Date of Birth:
(e.g., MM/DD/YYYY
format)
Member ID:
(e.g., ZPOS123 45 6789
Do not use hyphens.)
Previous Home Address (for verification purposes)
Street Address 1:
Street Address 2:
City, State, Zip: ,   
Daytime Phone: - -

New Home Address
Street Address 1:
Street Address 2:
City, State, Zip: ,   
Daytime Phone: - -

Note: To submit an online request or change, you must be a member of the Highmark Blue Cross Blue Shield West Virginia health plan, or a group benefits administrator authorized to make requests or changes on the member's behalf.

Important!
Please review your information carefully before continuing. All information above is required and must be accurate to submit and complete your request.

 

 


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Highmark Blue Cross Blue Shield West Virginia is an independent licensee of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. The Blue Cross and Blue Shield symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield companies.

Highmark Blue Cross Blue Shield West Virginia serves the state of West Virginia and Washington County, Ohio.