Highmark NY 2027: Three Things to Do Now
D-SNP Network Correction, ANOCs Are Out, and Certification Is Live
Several moving pieces from Highmark this week. One of them needs your attention today.
Highmark sent through a packed update on 2027 D-SNP products, SSBCI, and certification requirements. Here's what matters for your business, starting with the item that could affect conversations you're already having.
Action Required: Your Product Guide May Have Wrong Hospital Data
If you picked up a Product Guide at a Highmark broker rollout meeting before September 11, the D-SNP in-network hospital information may be incorrect for West Virginia and Delaware.
Stop using those pages for network questions in those two states. If you've already given a client hospital information from a pre-September 11 guide, follow up and verify before they make an enrollment decision on it.
Highmark is publishing a separate D-SNP Network Resource pulled from the corrected 2027 Product Guide. It goes live digitally within the next week, along with the 2027 Agent Field Guide.
2027 SSBCI: New Benefit Category and Updated Attestation Forms
Attestation forms are updated for 2027. Use these to help clients start the attestation process:
New for 2027: Everyday Essentials. SSBCI qualified Full Duals now get a spending category for household basics like cleaning supplies, laundry detergent, and toilet paper. Items are ordered through the PayForward online catalog. This is a real selling point for Full Dual prospects, so know it.
How members become qualified
Highmark confirms the qualifying condition and risk through internal data analysis, or the member's medical provider submits a Provider Attestation Form confirming they meet SSBCI eligibility criteria.
Two things that save your clients paperwork:
Former Highmark members who were SSBCI approved before disenrollment return to a Highmark D-SNP plan as SSBCI approved on day one. No additional paperwork.
All renewing Highmark D-SNP members stay SSBCI qualified for 2027 with no action required.
Flex Card reminders worth repeating to clients
Qualified members get an additional allowance on their Flex Card.
Members must activate their new Flex Card before use.
Funds do not roll over indefinitely.
Current Highmark members should keep their existing Flex Cards for 2027.
Funds and effective dates
If a member becomes eligible for SSBCI after their plan's effective date, the allowance carries over to the following month as a one-time exception. Per CMS rules, funds cannot be backdated prior to the approval date, and plans cannot offer a grace period while a member is going through approval.
Where to check status
Members can track approved funds at MyHealthyFlex.com or through the PayForward app, or call PayForward at 833-623-2619 (TTY 711), Monday through Friday, 8:00 AM to 8:00 PM.
Important: Sales Support cannot verify individual SSBCI eligibility or give status updates. Point members to Highmark notifications and the PayForward platform instead.
For the full list of qualifying conditions and program guidelines, review the complete 2027 SSBCI Resource.
2027 D-SNP ANOCs Are in the Mail
Highmark has started mailing Annual Notice of Change documents to D-SNP members. Your clients are receiving them now, which means the questions start now too. Download your copies so you're reading the same document they are.
Pennsylvania Western PA, Central and Northeastern PA, and Southeastern PA Highmark Wholecare Medicare Assured Diamond (HMO SNP) and Medicare Assured Ruby (HMO SNP)
Delaware Kent, New Castle, and Sussex Counties Highmark Health Options Duals (HMO SNP) and Duals Select (HMO SNP)
West Virginia Highmark Health Options Duals (HMO SNP)
Check the linked documents for the full county list in your service area. For questions on any ANOC, contact your Broker Manager.
Certification: Two Requirements, Both Mandatory
Highmark's 2027 MA and D-SNP Certification Training is live. This must be completed before you sell for the 2027 plan year.
One thing that trips people up: complete every module, including any still titled "2026." Those modules count toward your 2027 certification.
Access it by logging into the Producer Portal at producer.highmark.com. Highmark has a User Guide if you want the walkthrough.
You also need NABIP or AHIP. Highmark recognizes either one for 2027, and you only need one of the two. All requirements must be finished before you sell 2027 Medicare Advantage products.
If you go the AHIP route, verify you see the Highmark logo in the upper right corner so your completion connects to their systems.
To be clear: Highmark's own certification is separate from and in addition to NABIP or AHIP. Finishing one does not cover the other.
Need help? Contact the Highmark Senior Markets Sales Team at [email protected] or (800) 652-9459.
New York Agents: Webinar on October 7
Highmark is hosting a webinar covering 2027 plan year changes and client impacts for Western and Northeastern New York, spanning both Medicare Advantage and ACA plans.
Date: Wednesday, October 7, 2026 Time: 9:30 AM to 11:00 AM
Two notes. First, 2027 plan information will be emailed no later than September 18 so you can review before the meeting, so watch your inbox. Second, commission decisions for New York Medicare Advantage plans are still pending, and Highmark will communicate changes as they're determined.
This session covers New York plans only.
Questions?
Reach out to your Broker Manager, or contact our team and we'll help you track down what you need.
