BlueChoice HMO Young Adult $7,350 Claim Forms

If you need a form that is currently not available online, please call Member Services at the telephone number on your ID card.

Medical Claim
International Claim Form
(For care received out of network area)
Transition of Care
Membership Change Form for Maryland Residents (Off-Exchange)
  • Maryland residents who purchased their plan directly from CareFirst (and not through the Maryland Health Connection) can use this form to make changes to their membership information.
  • Maryland residents who purchased their plan through the Maryland Health Connection must contact the Exchange to make changes to their membership information.