CDH - BluePreferred - Group and Member Applications - District of Columbia

Note: If the group is adding a BlueFund HRA at renewal or purchasing it as a new group, the group must complete the BenefitWallet HRA Set-Up Form as well as the Employer ACH Authorization.


CDH - BluePreferred

Group SizeGroup Subscriber Enrollment FormGroup Contract ApplicationPoint of Enrollment
2-50 BlueFund BluePreferred HRA CUT5153 N/A N/A
2-50 BlueFund BluePreferred HSA CUT5153 N/A N/A
2-50 BluePreferred HSA or HRA Compatible Plans CUT5153 N/A N/A
2-50 BluePreferred High Deductible Health Plans CUT5153 N/A N/A
51+ BlueFund BluePreferred HRA CUT5153 DC/GHMSI/GCA/LG (R. 3/14) DC/GHMSI/CFBC/POE/
GCA/LG (R. 3/14)
51+ BluePreferred HSA or HRA Compatible Plans CUT5153 DC/GHMSI/GCA/LG (R. 3/14) DC/GHMSI/CFBC/POE/
GCA/LG (R. 3/14)
51+ BlueFund BluePreferred HSA CUT5153 DC/GHMSI/GCA/LG (R. 3/14) DC/GHMSI/CFBC/POE/
GCA/LG (R. 3/14)
51+ BluePreferred High Deductible Health Plans CUT5153 DC/GHMSI/GCA/LG (R. 3/14) DC/GHMSI/CFBC/POE/
GCA/LG (R. 3/14)

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Applications and Forms

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