BlueChoice Advantage Group and Member Applications - Maryland
Group Size | Group Subscriber Enrollment Form | Group Contract Application | Point of Enrollment |
---|---|---|---|
MSGR (2-50) | N/A | N/A | N/A |
MSGR (Self-Employed) | N/A | N/A | N/A |
For MD groups headquartered in Prince George's or Montgomery counties.
Group Size | Group Subscriber Enrollment Form | Group Contract Application | Point of Enrollment |
---|---|---|---|
2-50 NON-MSGR | CUT6984 | N/A | N/A |
51+ | CUT6984 | MD/GHMSI/CFBC/POS-POE/GCA/LG (11/18) | MD/GHMSI/CFBC/POS-POE/GCA/LG (11/18) |
For MD groups headquartered in counties other than Prince George's and Montgomery.
Group Size | Group Subscriber Enrollment Form | Group Contract Application | Point of Enrollment |
---|---|---|---|
2-50 NON-MSGR | CUT6984 | N/A | N/A |
51+ | CUT6984 | CFMI/CFBC/POS-POE/GCA/LG (11/18) | CFMI/CFBC/POS-POE/GCA/LG (11/18) |