ATTENTION: CareFirst will file Federal RxDC reports for 2024 by June 1, 2025. All current clients with medical or pharmacy products through CareFirst in 2024 must complete the Annual RxDC Information Submission form under Quick Links by May 12, 2025, to be included in CareFirst's D1-Premium & Life Years data filing.
Change Healthcare notifying individuals of data breach. Learn more here.
Medicare Forms & Fliers
2025 Documents
2025 Pre-Enrollment Forms
2025 Permission to Contact Form (PDF) English | Spanish |
2025 Scope of Appointment (PDF) English | Spanish |
2025 PreEnrollment Checklist (PDF) English | |
2025 PPO Documents
2025 Presales Book – Complete (PDF) English | Spanish |
2025 Presales Book - Complete and Essential (PDF) English | Spanish |
2025 Presales Book- Salute (PDF) English | Spanish |
2025 Enrollment Form – Complete and Essential (PDF) English | Spanish |
2025 Enrollment Form – Salute (PDF) English | Spanish |
2025 Summary of Benefits – Complete (PDF) English | Spanish |
2025 Summary of Benefits – Essential (PDF) English | Spanish |
2025 Summary of Benefits – Salute (PDF) English | Spanish |
2025 HMO-SNP Documents
2025 Enrollment Form – DualPrime (PDF) English | Spanish |
2025 Presales Book – DualPrime (PDF) English | Spanish - Coming Soon |
2025 Summary of Benefits – DualPrime (PDF) English | Spanish - Coming Soon |
Medicare Advantage Post-Enrollment Forms
Prescription Claim Form (PDF) |
Appointment of Personal Representative (PDF) |
MedPlus Agent Contracting
Agent/Agency Update Form (PDF) General Agency Use |
General Agency Contacts for New Agents (PDF) |
Consumer Direct Products Independent Contractor Form (PDF) Agent Use |
MedPlus Pre-Enrollment
Replacement of Coverage Form (PDF) |
Broker Acknowledgement Form (PDF) |
Pre-Sales books: |
MedPlus Post-Enrollment
MedPlus Household Discount Request Form (PDF) |
Membership Change Form (PDF) |
Reinstatement Request Form (PDF) |
Authorization for Access to Personal Information (PDF) HIPAA release |
General
Medicare Advantage
Medicare Advantage Supplemental Vendors
Nations Hearing
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SilverSneakers Fitness
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Blue365 Flier (PDF) |
MedPlus
MedPlus Sales Brochure (DC) (PDF) |
MedPlus Sales Brochure (VA) (PDF) |
MedPlus Sales Brochure (MD) (PDF) |
Medicare & MedPlus 2023 Updates (PDF) |
CareFirst Dental - It's the Right Decision Flier (PDF) |
SilverSneakers Fitness
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Blue365 Flier (PDF) |