BlueChoice Advantage - Small Group Off-SHOP Applications - Virginia
BlueChoice Advantage (including HSA/HRA)
Group Size | Group Subscriber Enrollment Form | Group Contract Application | Point of Enrollment |
---|---|---|---|
2-50 | SUM6129 (for plans effective 1/1/21 and 12/31/23) SUM6620 (for plans effective 1/1/24 and after) |
VA/GRPAPP/HCR (1/23) (POS) | VA/GRPAPP/HCR (1/23) (POE) |