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BlueChoice Advantage Group and Member Applications - Virginia

BlueChoice Advantage

Group Size Group Subscriber Enrollment Form Group Contract Application Point of Enrollment
2-50 (product other than VA E&S) CUT6986 N/A N/A
51+ (product other than VA E&S) CUT6986 VA/CFBC/GCA/LG (R. 3/14) (BCAdv, HBAdv) VA/GHMSI/CFBC/
POE/GCA/LG (R. 3/14)