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 & 51+ Freestanding (not certified ACA benchmark plans; benefits include dental services for adults and children)
|
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 & 51+ Freestanding (not certified ACA benchmark plans; benefits include dental services for adults and children)
|
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) |