Forms for State of Maryland Employees - CareFirst BlueCross BlueShield

Forms

Please select a form from the table below:

Forms

BlueCard Worldwide International Claim
(for PPO members receiving care out of the country)

Disability Dependent Certification Form

HIPAA Authorization Form for Information Release

HIPAA Designation of Personal Representative
(expires when policy terminates)

HIPAA Revocation Form for Information Release
(expires one year from date of signature)

Medical/Vision Claim Form

PCP Selection - CareFirst BlueChoice (HMO)

PCP Selection - Point of Service (POS)

Prospective Member's Transition of Care

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2009 Open Enrollment Health Fair Schedule

Member ID Cards

Select or Change your PCP

Order ID Cards

Nurse Line (FirstHelp)

Frequently Asked Questions

Hearing Impaired Telephone Numbers

What's New for 2009/2010 Plan Year?

Health & Wellness

	My Care First
	Options Discount Program
	Blue365 - More Wellness Savings
	Health & Wellness Services

	New Member ID Card Information
	What is an EPO Plan?
	Customer Service Hours
	Open Enrollment Hotline
	Get monthly health news by e-mail
	Vitality Member Newsletter
	News Archives

Report Fraud

Confidentiality Statement

Members' Rights & Responsibilities

Return to State of Maryland Home Page

Serving Maryland, the District of Columbia and portions of Virginia. CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., 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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