BluePreferred PPO - Small Group On-SHOP Applications - Virginia
BluePreferred PPO (including HSA/HRA)
Group Size | Group Subscriber Enrollment Form | Group Contract Application |
---|---|---|
2-50 | SUM6125 (for plans effective 1/1/21 and 12/31/23) SUM6617 (for plans effective 1/1/24 and after) |
VA/GRPAPP/HCR (1/21) (HIX) (for plans effective 1/1/21 and 12/31/23) VAGRPAPP-HCR (R. 1-24) (for plans effective 1/1/24 and after) |