Please be advised, the Broker Portal and Broker Express will undergo maintenance from 3 pm Friday 4/19th to 4 am Monday 4/22nd The applications will be inaccessible during this time.
CDH - BlueChoice Opt-Out Plus Open Access - Group and Member Forms and Applications - District of Columbia
Note: If the group is adding a BlueFund HRA at renewal or purchasing it as a new group, the group must complete the HRA Set-Up Form as well as the Employer ACH Authorization.
CDH - BlueChoice Opt-Out Plus Open Access
| Group Size | Group Subscriber Enrollment Form | Group Contract Application | Point of Enrollment |
|---|---|---|---|
| 2-50 BlueFund BlueChoice Opt-Out Plus HRA | CUT5148 | N/A | N/A |
| 2-50 BlueFund BlueChoice Opt-Out Plus HSA | CUT5148 | N/A | N/A |
| 2-50 BlueChoice Opt-Out Plus HSA or HRA Compatible Plans | CUT5148 | N/A | N/A |
| 2-50 BlueChoice Opt-Out Plus High Deductible Health Plans | CUT5148 | N/A | N/A |
| 51+ BlueFund BlueChoice Opt-Out Plus HRA | CUT5148 | DC/GHMSI/CFBC/POS/ GCA/LG (R. 3/14) |
DC/GHMSI/CFBC/POE/ GCA/LG (R. 3/14) |
| 51+ BlueFund BlueChoice Opt-Out Plus HSA | CUT5148 | DC/GHMSI/CFBC/POS/ GCA/LG (R. 3/14) |
DC/GHMSI/CFBC/POE/ GCA/LG (R. 3/14) |
| 51+ BlueFund BlueChoice Opt-Out Plus HSA or HRA Compatible Plans | CUT5148 | DC/GHMSI/CFBC/POS/ GCA/LG (R. 3/14) |
DC/GHMSI/CFBC/POE/ GCA/LG (R. 3/14) |
| 51+ BlueChoice Opt-Out Plus High Deductible Health Plans | CUT5148 | DC/GHMSI/CFBC/POS/ GCA/LG (R. 3/14) |
DC/GHMSI/CFBC/POE/ GCA/LG (R. 3/14) |