Home > Our Plans > Group > Request for Additional Information

Request for Additional Information

Thank you for your interest in Highmark Blue Cross Blue Shield West Virginia.
We look forward to providing you additional information on why we are West Virginia's leader in providing health coverage.

Items listed with an * are required fields.
Contact Name:*
Business Name:*
Business Address:
City:
State:
Zip:
County:*
E-Mail Address:*
Phone Number:
( ) -
Extension:
Fax Number:
( ) -
Number of full-time employees:
Currently offer group health insurance?:
Present Insurance anniversary month:
Best time to reach you:
How would you like to be contacted?
 

 


® Highmark is a registered mark of Highmark Health Services. © 2013 Highmark Health Services, All Rights Reserved

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.