Dental - Maryland

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Freestanding Preferred (PPO), Traditional, BlueDental Plus, BlueDental EPO & BlueDental Basic GHMSI

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)
  • 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)
 
 

Freestanding Preferred (PPO), Traditional, BlueDental Plus, BlueDental EPO & BlueDental Basic CFMI

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)
  • 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)
 
 

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