Highmark Blue Cross Blue Shield
adultBasic

adultBasic

Apply for adultBasic

There is one application form (PDF) for both CHIP and adultBasic. Families can apply for CHIP and adultBasic at the same time using the same form. There are several ways you can apply for coverage. If you have any questions about the application or the income documents you need to submit, please call us weekdays toll free 1-800-543-7105.

Method

Instructions

Mail:

You can print out an insurance application form (PDF), attach income documentation, complete and sign the form and mail or fax it with income documents to Highmark.

Mail the completed application and copies of income documentation to:

Highmark CHIP and adultBasic
P.O. Box Caring
Pittsburgh, PA 15230-9779

Fax:

You can fax the completed application with income documents to
1-412-544-1657.

Online:

You can complete a COMPASS (Commonwealth of Pennsylvania Access to Social Services) application on-line. This system will evaluate the application for eligibility in many state programs including Medicaid, CHIP and adultBasic.

Phone:

If you have questions, please call toll-free at
1-800-543-7105.