Dental - Maryland

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

Group Size	Group Subscriber Enrollment Form	Group Contract Application
2-50 MSGR (Grandfathered/Non-ACA)	SUM1038	N/A
2-50 Freestanding (ACA-compliant member level rated plans) BlueDental Preferred BlueDental Traditional	SUM2029	MD/GHMSI/SG/DENT-VIS/GCA (1/17)
2-50 & 51+ Freestanding (not certified ACA benchmark plans; benefits include dental services for adults and children) BlueDental Plus BlueDental EPO BlueDental Basic Preferred Dental Traditional Dental	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 Size	Group Subscriber Enrollment Form	Group Contract Application
2-50 MSGR (Grandfathered/Non-ACA)	SUM1037	N/A
2-50 Freestanding (ACA-compliant member level rated plans) BlueDental Preferred BlueDental Traditional	SUM2029	CFMI/SG/DENT-VIS/GCA (1/17)
2-50 & 51+ Freestanding (not certified ACA benchmark plans; benefits include dental services for adults and children) BlueDental Plus BlueDental EPO BlueDental Basic Preferred Dental Traditional Dental	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)