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BluePreferred PPO - Small Group Off-SHOP Applications - Virginia
BluePreferred PPO (including HSA/HRA)
| Group Size | Group Subscriber Enrollment Form | Group Contract Application | Point of Enrollment |
|---|---|---|---|
| 2-50 | SUM6130 (for plans effective 1/1/23 and 12/31/23) SUM6621 (for plans effective 1/1/24 and after) |
VA/GRPAPP/HCR (1/23) (PPO) | VA/GRPAPP/HCR (1/23) (POE) |