HealthyBlue Advantage - 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 | SUM5850 (for plans effective between 1/1/22 and 12/31/22) SUM6512 (for plans effective 1/1/23 and after) |
MD/SE/POS/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 | SUM5853 (for plans effective between 1/1/22 and 12/31/22) SUM6515 (for plans effective 1/1/23 and after) |
CFMI/SE/POS/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) |