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)