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)

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	Member ID Cards
	Select or Change your PCP
	Order ID Cards
	Nurse Line (FirstHelp)
	Frequently Asked Questions
	Contact Us
	State of Maryland - Health Benefits and Wellness Information
	Health & Wellness - My CareFirst (En Español)
	Options Discount Program
	www.carefirst.com

	Important Changes to BlueChoice Vision and PPO Member ID Cards
	Burrell Named New President and CEO
	Customer Service Hours
	NEW! Sign up for e-health newsletters
	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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