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.
BluePreferred PPO - Small Group Off-SHOP Applications - Maryland
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 | SUM6867 (for plans effective between 1/1/24 and 12/31/24) SUM7160 (for plans effective 1/1/25 and after) |
MD/CF/SE/PPO/GCA (R. 1/19) (for plans effective 1/1/19 and after) | MD/SE/POE/GCA (R. 1/19) (for plans effective 1/1/19 and after) |
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 | SUM6865 (for plans effective between 1/1/24 and 12/31/24) SUM7158 (for plans effective 1/1/25 and after) |
CFMI/SE/PPO/GCA (R. 1/19) (for plans effective 1/1/19 and after) | CFMI/SE/POE/GCA (R. 1/19) (for plans effective 1/1/19 and after) |