CDH - BlueChoice HMO Open Access - Virginia
Note: If the group is adding a BlueFund HRA at renewal or purchasing it as a new group, the group must complete the HRA Plan Design Guide as well as the Employer ACH Authorization.
CDH - BlueChoice HMO Open Access
Group Size | Group Subscriber Enrollment Form | Group Contract Application | Point of Enrollment |
---|---|---|---|
2-50 BlueFund BlueChoice HSA (product other than VA & ES) | CUT6191 | N/A | N/A |
2-50 BlueChoice HSA or HRA Compatible Plans (product other than VA & ES) | CUT6191 | N/A | N/A |
2-50 BlueFund BlueChoice HRA (product other than VA & ES) | CUT6191 | N/A | N/A |
2-50 BlueChoice High Deductible Health Plans (product other than VA & ES) | CUT6191 | N/A | N/A |
51+ BlueFund BlueChoice HSA (product other than VA & ES) | CUT6191 | VA/CFBC/GCA/LG (R. 3/14) (BC(HMO), BCOO(OA), HB(HMO), HB2) | VA/GHMSI/ CFBC/POE/ GCA/LG (R. 3/14) |
51+ BlueChoice HSA or HRA Compatible Plans (product other than VA & ES) | CUT6191 | VA/CFBC/GCA/LG (R. 3/14) (BC(HMO), BCOO(OA), HB(HMO), HB2) | VA/GHMSI/ CFBC/POE/ GCA/LG (R. 3/14) |
51+ BlueFund BlueChoice HRA (product other than VA & ES) | CUT6191 | VA/CFBC/GCA/LG (R. 3/14) (BC(HMO), BCOO(OA), HB(HMO), HB2) | VA/GHMSI/ CFBC/POE/ GCA/LG (R. 3/14) |
51+ BlueChoice High Deductible Health Plans (product other than VA & ES) | CUT6191 | VA/CFBC/GCA/LG (R. 3/14) (BC(HMO), BCOO(OA), HB(HMO), HB2) | VA/GHMSI/ CFBC/POE/ GCA/LG (R. 3/14) |