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.

Reinstatement Request

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

Viewing and printing this document requires Adobe Acrobat Reader, which can be downloaded free from the Adobe site.