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.
BlueFund CDH - BlueChoice Opt-Out Plus Open Access - Group and Member Forms and Applications - 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.
Group Size | Group Subscriber Enrollment Form | Group Contract Application | Point of Enrollment |
---|---|---|---|
MSGR (2-50) BlueFund BlueChoice Opt-Out Plus HSA | SUM1039 | N/A | N/A |
MSGR (2-50) BlueFund BlueChoice Opt-Out Plus HSA Compatible Plan | SUM1039 | N/A | N/A |
MSGR (2-50) BlueChoice Opt-Out Plus High Deductible Health Plans | SUM1039 | 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 BlueFund BlueChoice Opt-Out Plus HRA | CUT5139 | N/A | N/A |
2-50 NON-MSGR BlueFund BlueChoice Opt-Out Plus HSA | CUT5139 | N/A | N/A |
2-50 NON-MSGR BlueChoice Opt-Out Plus HSA or HRA Compatible Plans | CUT5139 | N/A | N/A |
2-50 NON-MSGR BlueChoice Opt-Out Plus High Deductible Health Plans | CUT5139 | N/A | N/A |
51+ BlueFund BlueChoice Opt-Out Plus HSA | CUT5139 | MD/GHMSI/ CFBC/POS-POE/ GCA/LG (1/18) |
MD/GHMSI/ CFBC/POS-POE/ GCA/LG (11/18) |
51+ BlueFund BlueChoice Opt-Out Plus HRA | CUT5139 | MD/GHMSI/ CFBC/POS-POE/ GCA/LG (1/18) |
MD/GHMSI/ CFBC/POS-POE/ GCA/LG (11/18) |
51+ BlueChoice Opt-Out Plus HSA or HRA Compatible Plans | CUT5139 | MD/GHMSI/ CFBC/POS-POE/ GCA/LG (1/18) |
MD/GHMSI/ CFBC/POS-POE/ GCA/LG (11/18) |
51+ BlueChoice Opt-Out Plus High Deductible Health Plans | CUT5139 | MD/GHMSI/ CFBC/POS-POE/ GCA/LG (1/18) |
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 Opt-Out Plus HRA | CUT8515 | N/A | N/A |
2-50 NON-MSGR BlueFund BlueChoice Opt-Out Plus HSA | CUT8515 | N/A | N/A |
2-50 NON-MSGR BlueFund BlueChoice Opt-Out Plus HSA or HRA Compatible Plans | CUT8515 | N/A | N/A |
2-50 NON-MSGR BlueChoice Opt-Out Plus High Deductible Health Plans | CUT8515 | N/A | N/A |
51+ BlueFund BlueChoice Opt-Out Plus HRA | CUT8515 | CFMI/CFBC/ POS-POE/GCA/ LG (11/18) |
CFMI/CFBC/ POS-POE/GCA/ LG (11/18) |
51+ BlueFund BlueChoice Opt-Out Plus HSA | CUT8515 | CFMI/CFBC/ POS-POE/GCA/ LG (11/18) |
CFMI/CFBC/ POS-POE/GCA/ LG (11/18) |
51+ BlueFund BlueChoice Opt-Out Plus HSA or HRA Compatible Plans | CUT8515 | CFMI/CFBC/ POS-POE/GCA/ LG (11/18) |
CFMI/CFBC/ POS-POE/GCA/ LG (11/18) |
51+ BlueChoice Opt-Out Plus High Deductible Health Plans | CUT8515 | CFMI/CFBC/ POS-POE/GCA/ LG (11/18) |
CFMI/CFBC/ POS-POE/GCA/ LG (11/18) |