BlueChoice Advantage Group and Member Applications - Maryland

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Group Size Group Subscriber Enrollment Form Group Contract Application Point of Enrollment
MSGR (2-50) N/A N/A N/A
MSGR (Self-Employed) N/A N/A N/A

For MD groups headquartered in Prince George's or Montgomery counties.

Group Size Group Subscriber Enrollment Form Group Contract Application Point of Enrollment
2-50 NON-MSGR CUT6984 N/A N/A
51+ CUT6984 MD/CFBC/BC-BCOO-OA/GCA/LG (1/14) (BC Advantage or HealthyBlue Advantage ONLY) MD/GHMSI/CFBC/POE/GCA/LG (1/14)

For MD groups headquartered in counties other than Prince George's and Montgomery.

Group Size Group Subscriber Enrollment Form Group Contract Application Point of Enrollment
2-50 NON-MSGR CUT6984 N/A N/A
51+ CUT6984 MD/CFBC/BC-BCOO-OA/GCA/LG (1/14) (BC Advantage or HealthyBlue Advantage ONLY) CFMI/CFBC/POE/GCA/LG (1/14)

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Go to Maryland Group Applications
and Forms

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Please contact your CareFirst Sales Representative.

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