Due to a planned data migration beginning Friday, July 11 at 11:00 p.m., and continuing through Monday, July 14 at 8:00 a.m., you may experience a delay in your information appearing on CareFirst portals. We expect that changes to member data will be reflected on the portals by Tuesday, July 15. Your patience is appreciated.
Change Healthcare notifying individuals of data breach. Learn more here.
BlueChoice HMO and BlueChoice HMO Open Access Group and Member Applications - Maryland
Non-MSGR MD Groups: If a group chooses BlueChoice medical coverage (HealthyBlue, BlueChoice, BlueChoice Open Access, BlueChoice Opt-Out Open Access, or BlueChoice Opt-Out Plus Open Access ) and indemnity dental coverage (Traditional or Preferred), and elects to offer non-parallel enrollment for dental, the group will receive a GHMSI or CFMI Non-Ridered Dental contract. In this case, the group is required to sign two Group Contract Applications (BlueChoice & GHMSI or CFMI), unless the group selects a Point-of-Enrollment package, which only requires the signed Point-of-Enrollment Group Contract Application. In this situation, an employee must complete two subscriber Enrollment Forms (BlueChoice & GHMSI or CFMI).
MSGR MD Groups: If a group chooses BlueChoice medical coverage (HealthyBlue, BlueChoice, BlueChoice Open Access, BlueChoice Opt-Out Open Access, or BlueChoice Opt-Out Plus Open Access ) and indemnity dental coverage (Traditional or Preferred), and elects to offer non-parallel enrollment for dental, the group will receive a GHMSI or CFMI Non-Ridered Dental contract. In this case, the group is required to sign two Group Contract Applications (BlueChoice & GHMSI or CFMI) and an employee must complete two subscriber Enrollment Forms (BlueChoice & GHMSI or CFMI). Note: For MSGR groups, retirees are not eligible for coverage under BlueChoice and/or non-parallel dental/vision.
For MD groups headquartered in Prince George's and Montgomery counties.
Group Size | Group Subscriber Enrollment Form | Group Contract Application | Non-Parallel Dental/ Vision Only |
---|---|---|---|
MSGR (2-50) | SUM1039 | N/A | N/A |
MSGR (Renewing Self-Employed) | N/A | N/A | N/A |
For MD groups headquartered in counties other than Prince George's and Montgomery.
Group Size | Group Subscriber Enrollment Form | Group Contract Application | Non-Parallel Dental/ Vision Only |
---|---|---|---|
MSGR (2-50) | SUM1039 | N/A | N/A |
MSGR (Renewing 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 | Non-Parallel Dental Only |
---|---|---|---|---|
2-50 NON-MSGR | CUT5609 | N/A | N/A | N/A |
51+ | CUT5609 | MD/CFBC/GCA/LG (11/18) | MD/GHMSI/ CFBC/POS-POE/ GCA/LG (11/18) |
MD/GHMSI GRP APP (R. 1/13) (GHMSI BP & Med with NonRdr D-V 1/13) AND CUT5141 |
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 | Non-Parallel Dental Only |
---|---|---|---|---|
2-50 NON-MSGR | CUT5609 | N/A | N/A | N/A |
51+ | CUT5609 | MD/CFBC/ GCA/LG (11/18) |
CFMI/CFBC/ POS-POE/GCA/LG (11/18) |
CFMI/GCA (R. 1/13) (CFMI BP & Med with NonRdr D-V 1/13) |