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.
2017 Plans for Residents of Maryland
2017 Plans for Residents of Virginia
|BlueChoice HMO Young Adult $7,150|
|BlueChoice HMO HSA Silver $1,500|
|BluePreferred PPO HSA Silver $2,000|
|BlueChoice HMO Silver $3,500|
|BlueChoice Plus Silver $2,500|
|HealthyBlue PPO Gold $1,000|
|HealthyBlue HMO Gold $1,000|
2017 Plans for Residents of Washington, D.C.
2016 Plans for Residents of Maryland and Virginia
2016 Plans for Residents of Washington, D.C.
Proof of Coverage
For members who purchased their plan directly from CareFirst and not through a state Exchange.