BlueChoice Advantage Group and Member Applications


Notes

  1. Applications and forms inside gray-shaded boxes must be ordered by calling (202) 479-8595 or your CareFirst Sales Representative.
  2. All other forms can be ordered by contacting the Literature Resource Center.
  3. Viewing and printing these documents requires Adobe Acrobat.
  4. If you do not already have this program, you can download it free from the Adobe site.

Instructions

Download Single Form:
Use the grid below to download and print a form. Adobe Acrobat PDF

Ordering Multiple Copies:
Please contact your CareFirst Sales Representative.

Additional instructions for completing Enrollment Forms are available on the Miscellaneous Forms page.


Maryland:

Group Size
New Group Subscriber Enrollment Form
Subsequent Enrollee and Late Entrant Enrollment Form
  
Group Contract Application
Point of Enrollment
MSGR (2-50)
N/A;
N/A
  
N/A
N/A
MSGR (Self-Employed)
N/A 
N/A 
N/A 
N/A 
2-24 NON-MSGR
25+ NON-MSGR

Virginia:

Group Size
New Group Subscriber Enrollment Form
Subsequent Enrollee and Late Entrant Enrollment Form
  
Group Contract Application
Point of Enrollment
2-24 (product other than VA E&S)  
25+ (product other than VA E&S)  

District of Columbia:

Group Size
New Group Subscriber Enrollment Form
Subsequent Enrollee and Late Entrant Enrollment Form
  
Group Contract Application
Point of Enrollment
2-24  
25+  

Adobe Acrobat PDF Viewing and printing this document requires Adobe Acrobat Reader, which can be downloaded free from the Adobe site.

Serving Maryland, the District of Columbia and portions of Virginia. CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc.

CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association.

® Registered trademark of the Blue Cross and Blue Shield Association. ®' Registered trademark of CareFirst of Maryland, Inc.
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