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BlueChoice HMO - Small Group On-SHOP Applications - Virginia
BlueChoice HMO (including HSA/HRA)
| Group Size | Group Subscriber Enrollment Form | Group Contract Application |
|---|---|---|
| 2-50 | SUM6127 (for plans effective 1/1/23 and 12/31/23) SUM6618 (for plans effective 1/1/24 and after) |
VA/GRPAPP/HCR (1/21)(HIX) (for plans effective 1/1/21 and 12/31/23) VA-GRPAPP-HCR (R. 1-24)-HIX (for plans effective 1/1/24 and after) |