Signature 65 Transition to Freedom Blue PPO Medicare Advantage Plan
The effective date of this transition will be January 1, 2025.
Benefits are listed by your Highmark group number. You were provided your group number when you enrolled in AHCP or when you transitioned to Signature 65 coverage. You may also contact the Central Benefits Office or Highmark to obtain your group number. View the booklets page to review your plan information.
Forms
Agreement to Cancel AHCP Form
Annuitant Health Care Change Form
Auto Debit Banking Form
Delayed AHCP Election Form
Delayed Surviving Spouse Election Form
Disabled Dependent Certification Form
Major Medical Claim Form
Student Certification Form
Additional Information
Identity Protection Services from Experian
Blue 365 Discount
How to Print a Temporary ID Card
Medicare Benefits Summary
Medicare Part D Notice of Creditable Coverage
Signature 65 Prescription Drug Discount Plan
BlueCross BlueShield International Travel (Pertains to Under 65 PPO members only)
Note: If enrolled in Signature 65 and are traveling internationally, members submit out of network claims directly to Highmark using the address on the back of their ID card and label the claim as a "foreign claim." The claim will be processed against the Major Medical benefit as Medicare would not apply.
Vendors
Highmark Blue Shield 1-888-745-3212
State Employees' Retirement System (SERS) 1-800-633-5461
Public School Employees' Retirement System (PSERS) 1-888-773-7748
Alternative Retirement Plan (ARP)
Fidelity 1-800-343-0860
TIAA 1-800-842-2252
Other Helpful Links
Medicare 1-800-633-4227
Social Security Administration 1-800-772-1213
Have a comment or suggestion for the website? Email your feedback!
Have a question?
Email: RetireeBenefitHelp@passhe.edu
Phone: 717-720-4153
FAX: 717-720-4162
Pennsylvania’s State System
of Higher Education
System Office - AHCP Benefits
2300 Vartan Way, Suite 207
Harrisburg PA 17110