Order ID Card - State of Maryland Employees

Order ID Card

To order a new ID card, please fill out the form below or contact Member Services.

Note: POS and HMO members must indicate their Primary Care Physician (PCP).

First Name:

Last Name:

Address Line 1:

Address Line 2:

(optional)

City:

State:

Zip:

Country:

Day Phone:

Night Phone:

E-mail:

Preferred Method of Contact: (optional)

(If your question is regarding claims or eligibility we may need to contact you by phone.)

Day Phone Night Phone E-mail Regular Mail

What Type of Insurance Do You Have?

CareFirst BlueChoice (HMO)

Point of Service (POS)

Preferred Provider Organization (PPO)

Please List the Member Name(s):

(For each member listed below, a new card will be mailed to the policy holder.)

Member Name(s):

PCP's Name:
(Required for HMO and POS members)

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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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