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BluePreferred PPO - Small Group On-SHOP Applications - Virginia
BluePreferred PPO (including HSA/HRA)
| Group Size | Group Subscriber Enrollment Form | Group Contract Application |
|---|---|---|
| 2-50 | SUM6617 (for plans effective between 1/1/24 and 12/31/24) SUM6925 (for plans effective 1/1/25 and after) |
VAGRPAPP-HCR (R. 1-24) (for plans effective between 1/1/24 and 12/31/24) VAGRPAPP-HCR (R. 1-25) (for plans effective 1/1/25 and after) |