BluePreferred PPO Medical 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 (MD, DC and Northern VA)
For services received in the MD, DC and Northern Virginia CareFirst service area.
Medical Claim (Other Service Areas)
For services received in areas other than the MD, DC and Northern Virginia
CareFirst service area.
International Claim Form
(For care received out of network area)
Continuity of Care - Members in a Maryland Based Plan (PDF)
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.