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BlueFund CDH - BlueChoice HMO Open Access - Maryland
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.
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 BlueFund BlueChoice HSA | CUT5609 | N/A | N/A |
2-50 NON-MSGR BlueChoice HSA or HRA Compatible Plans | CUT5609 | N/A | N/A |
2-50 NON-MSGR BlueFund BlueChoice HRA | CUT5609 | N/A | N/A |
2-50 NON-MSGR BlueChoice High Deductible Health Plans | CUT5609 | N/A | N/A |
51+ BlueFund BlueChoice HSA | CUT5609 | MD/CFBC/GCA/LG (11/18) | MD/GHMSI/CFBC/POS-POE/GCA/LG (11/18) |
51+ BlueChoice HSA or HRA Compatible Plans | CUT5609 | MD/CFBC/GCA/LG (11/18) | MD/GHMSI/CFBC/POS-POE/GCA/LG (11/18) |
51+ BlueFund BlueChoice HRA | CUT5609 | MD/CFBC/GCA/LG (11/18) | MD/GHMSI/CFBC/POS-POE/GCA/LG (11/18) |
51+ BlueChoice High Deductible Health Plans | CUT5609 | MD/CFBC/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 BlueFund BlueChoice HSA | CUT5609 | N/A | N/A |
2-50 NON-MSGR BlueChoice HSA or HRA Compatible Plans | CUT5609 | N/A | N/A |
2-50 NON-MSGR BlueFund BlueChoice HRA | CUT5609 | N/A | N/A |
2-50 NON-MSGR BlueChoice High Deductible Health Plans | CUT5609 | N/A | N/A |
51+ BlueFund BlueChoice HSA | CUT5609 | MD/CFBC/GCA/LG (11/18) | CFMI/CFBC/POS-POE/GCA/LG (11/18) |
51+ BlueChoice HSA or HRA Compatible Plans | CUT5609 | MD/CFBC/GCA/LG (11/18) | CFMI/CFBC/POS-POE/GCA/LG (11/18) |
51+ BlueFund BlueChoice HRA | CUT5609 | MD/CFBC/GCA/LG (11/18) | CFMI/CFBC/POS-POE/GCA/LG (11/18) |
51+ BlueChoice High Deductible Health Plans | CUT5609 | MD/CFBC/GCA/LG (11/18) | CFMI/CFBC/POS-POE/GCA/LG (11/18) |