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CDH - BluePreferred - Group and Member 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 Plan Design Guide as well as the Employer ACH Authorization.
CDH - BluePreferred
| Group Size | Group Subscriber Enrollment Form | Group Contract Application | Point of Enrollment |
|---|---|---|---|
| 2-50 BlueFund BluePreferred HRA | CUT5153 | N/A | N/A |
| 2-50 BlueFund BluePreferred HSA | CUT5153 | N/A | N/A |
| 2-50 BluePreferred HSA or HRA Compatible Plans | CUT5153 | N/A | N/A |
| 2-50 BluePreferred High Deductible Health Plans | CUT5153 | N/A | N/A |
| 51+ BlueFund BluePreferred HRA | CUT5153 | DC/GHMSI/GCA/LG (R. 3/14) | DC/GHMSI/CFBC/POE/ GCA/LG (R. 3/14) |
| 51+ BluePreferred HSA or HRA Compatible Plans | CUT5153 | DC/GHMSI/GCA/LG (R. 3/14) | DC/GHMSI/CFBC/POE/ GCA/LG (R. 3/14) |
| 51+ BlueFund BluePreferred HSA | CUT5153 | DC/GHMSI/GCA/LG (R. 3/14) | DC/GHMSI/CFBC/POE/ GCA/LG (R. 3/14) |
| 51+ BluePreferred High Deductible Health Plans | CUT5153 | DC/GHMSI/GCA/LG (R. 3/14) | DC/GHMSI/CFBC/POE/ GCA/LG (R. 3/14) |