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Vision - Maryland

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For MD groups headquartered in Prince George's or Montgomery counties.

Group SizeGroup Subscriber Enrollment FormGroup Contract Application
2-50 Renewing
(Grandfathered/Non-ACA)

BlueVision Plus
SUM1038 N/A
2-50
(New & Renewing Groups)

BlueVision Plus
SUM2029 MD/GHMSI/SG/DENT-VIS/GCA (1/17) (for plans effective prior to 5/1/19)

MD/GHMSI/DN-VS ONLY/GCA (R. 11/18) (for plans effective 5/1/19 and after)
51+ Groups
(New & Returning Groups)

BlueVision Plus
SUM2711 MD/GHMSI DN-VS ONLY GRP APP (R. 1/13) (MD GHMSI DN-VS ONLY 10/16) (for plans effective prior to 5/1/19)

MD/GHMSI/DN-VS ONLY/GCA (R. 11/18) (for plans effective 5/1/19 and after)

For MD groups headquartered in counties other than Prince George's and Montgomery.

Group SizeGroup Subscriber Enrollment FormGroup Contract Application
2-50 Renewing
(Grandfathered/Non-ACA)

BlueVision Plus
SUM1037 N/A
2-50
(New & Renewing Groups)

BlueVision Plus
SUM2029 CFMI/SG/DENT-VIS/GCA (1/17) (for plans effective prior to 5/1/19)

CFMI/DN-VS ONLY/GCA (R. 11/18) (for plans effective 5/1/19 and after)
51+ Groups
(New & Returning Groups)

BlueVision Plus
SUM2711 CFMI/DN-VS ONLY GCA (R. 1/13) (CFMI DN-VS ONLY 10/16) (for plans effective prior to 5/1/19)

CFMI/DN-VS ONLY/GCA (R. 11/18) (for plans effective 5/1/19 and after)

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