Highmark Important Updates: Medigap, SSBCI, and Delaware D-SNP Information

Important Medigap Updates

Highmark is providing important updates regarding the 2026 Medigap plans to ensure you have the most current information for your clients.

The annual CMS updates for 2026 cost-sharing and revised deductible amounts for Plan F and Plan G-High Deductible (G-HD) have been finalized and incorporated into the 2026 Outline of Coverage (OOCs).

To ensure accuracy, please immediately cease using any previously printed 2026 OOCs.

The latest digital versions of the OOCs are available for download from the Producer Portal and Highmark Member Site.

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Producer Portal Updates

Highmark is also pleased to announce that Medigap plan availability beginning with January 1, 2026 effective dates for Southeastern Pennsylvania (SEPA) and Pennsylvania G-HD are now live and fully accessible within the Producer Portal.

As a reminder, all Medigap applications must be submitted via the Producer Portal.

You can access the Producer Portal by clicking here to begin submitting your Medigap applications.

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Member Notification of D-SNP SSBCI Qualification Change

Please be advised of upcoming changes to D-SNP Special Supplemental Benefits for the Chronically Ill (SSBCI) Qualification Status and associated Member Notifications, effective January 1, 2026.

Highmark D-SNP members experiencing a change in their SSBCI flex card qualification status will be notified through two channels:

• Direct Mail: Members will receive a letter detailing their qualification status change.
• Automated Phone Call: Members will receive a call with important details telling them whether or not they have qualified.

What constitutes a "status impact" for notification?

• Becoming Qualified: A member goes from non-qualified to qualified through a claims sweep or Provider Attestation.
• Remaining Non-Qualified (after attestation): A member is non-qualified, went through Provider Attestation, but the Provider determined they were still not qualified.

Important Note for Members Deemed Not Qualified:

If a Provider deems a D-SNP member not qualified, that member still has the opportunity to become qualified later if their status changes via claims sweep or a new Provider Attestation during their Highmark enrollment.

Be aware of these new notification methods and the various scenarios that trigger them, especially the continued opportunity for members to qualify even after an initial "not qualified" determination. This will help your clients self-serve in understanding their benefit status.

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Delaware D-SNP Monthly Enrollment & Medicaid Alignment

Highmark is pleased to confirm that Delaware D-SNP plans now permit monthly enrollment switching, as Highmark is now a Fully Integrated D-SNP (FIDE). Remember that when enrolling someone in a FIDE D-SNP in Delaware, their Medicaid plan automatically switches to match the same carrier.

Please remember that Pennsylvania D-SNP plans continue to primarily utilize the Annual Enrollment Period (AEP) and various Special Enrollment Periods (SEPs) for enrollment changes.

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Plan Termination Special Enrollment Period (SEP)

The Plan Termination SEP, running from December 8th through the last day in February, provides an opportunity for members whose plans are terminating on December 31st to enroll in a new plan for the following year.

As a reminder, if an impacted member enrolls into a plan during AEP, they still retain their SEP and can switch their enrollment between December 8 - December 31, 2025 for an effective date of January 1, 2026.

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