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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

Plan Termination

Proof of Coverage

Reinstatement Request

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