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Maryland Small Group Off-SHOP Applications and Forms

A variety of applications and other forms are available.

Please contact your Account Manager or Broker Representative to ensure that you have the correct forms.  Please choose from the list below:

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BlueChoice HMO Referral

Group & Member Applications
Miscellaneous Forms

BlueChoice HMO

Group & Member Applications
Miscellaneous Forms

BlueChoice Plus / BlueChoice Plus Opt-Out

Group & Member Applications
Miscellaneous Forms

BlueChoice Advantage

Group & Member Applications
Miscellaneous Forms

BluePreferred PPO

Group & Member Applications
Miscellaneous Forms

HealthyBlue HMO

Group & Member Applications
Miscellaneous Forms

HealthyBlue Plus

Group & Member Applications
Miscellaneous Forms

HealthyBlue Advantage

Group & Member Applications
Miscellaneous Forms

HealthyBlue PPO

Group & Member Applications
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Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the business name of CareFirst Advantage, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. In the District of Columbia and Maryland, CareFirst MedPlus is the business name of First Care, Inc. In Virginia, CareFirst MedPlus is the business name of First Care, Inc. of Maryland (Used in VA by: First Care, Inc.). CareFirst of Maryland, Inc., Group Hospitalization and Medical Services, Inc., CareFirst Advantage, Inc., Trusted Health Plan (District of Columbia), Inc., CareFirst BlueChoice, Inc., First Care, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only.


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