Grandfathered Plan Medical Forms

These forms are to be used if you have a "grandfathered" plan, an individual or family plan into which you enrolled before the Affordable Care Act was signed into law on March 23, 2010.

  • If you are unsure of the 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.

Grandfathered Medical Plans

BlueChoice (HMO)
BluePreferred
Catastrophic
Personal Comp

Plan Termination

View Form (applies to all plans)

Proof of Coverage

Social Security Number Submission Form

Reinstatement Request

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

Gender Services

Hair Removal Services Reimbursement Form (applies to all plans)