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ACA Plan Medical Forms

These forms are to be used if you have an ACA plan you bought directly through CareFirst or your state's Insurance Marketplace or Exchange.

  • If you are unsure of what plan you have, look on your Member ID card. You may contact Member Services by calling the telephone number on your card.
  • Other Member Services contact numbers are also available.

2022 Plans for Residents of Maryland

2022 Plans for Residents of Virginia

2022 Plans for Residents of Washington, D.C.

2021 Plans for Residents of Maryland

2021 Plans for Residents of Virginia

2021 Plans for Residents of Washington, D.C.

Plan Termination

Proof of Coverage

Reinstatement Request

View Form
For members who purchased their plan directly from CareFirst and not through a state Exchange.