Below is a detailed checklist to assist you in enrolling your CareFirst New Group. We must receive a completed group prior to the CareFirst deadline (refer to the deadline table in the broker contract). Approval by CareFirst will be contingent upon receipt of all required information prior to the deadline. Missing information will cause a delay in processing your group coverage or a later effective date of coverage.
New Case Checklist:
Group Contract Application:
* For enrollment eligibility guidelines, please refer to Broker Express
Enrollment Forms:
Waiver Forms:
Broker of Record Letter OR:
Broker Signature on Contract Application
Signed & Dated Rate Query:
Check for one month's Premium (made payable to CareFirst, Inc.):
Student Certification Form:
Disability Certification Form:
Most Recent Quarterly Wage & Tax Statement (Indicating Status of Employees):
*Please note that payroll registers will be accepted in lieu of the most recent wage and tax statement when payroll register is filed as an amendment. This option should only be exercised on an exception basis when the Wage and Tax is not available. If a payroll register is provided, it must be generated by a payroll service and must not be generated by software via desktop computers.
W-4 - New Hires and Newly Formed Corporations
Life Insurance Forms:(If Applicable)
Master Application:
Enrollment Applications:
Renewal/Benefit Change Checklist:
Signed Rate Query:
Renewal Rate Acceptance Sheet:
Group Contract Application
(REQUIRED FOR: Contract Changes, Product Changes or Jurisdictional Changes)
BlueChoice Renewal Disclosure Statement
Waiver Form: (If Applicable)
Enrollment Forms: (If Applicable)
Student Certification Form(If Applicable)
Disability Certification Form: (If Applicable)
Cobra Applications: (If Applicable)
Life Insurance Forms: (If Applicable)
Master Application:
Enrollment Applications:
Signed Over 50 Group Rate Sheet:
Additional Items to be Submitted w/ Takeover Cases:
