BluePreferred 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.
Membership Change Form for Grandfathered Members of Maryland and Washington, D.C.
Member Update Form for Grandfathered Members of Virginia
eBilling (Automatic Debit)
International Claim Form
(For care received out of network area)
Coordination of Benefits
(Update your information on My Account)
Student Certification
For Maryland residents (excluding Prince George's and Montgomery Counties)
Student Certification
For Maryland (Prince George's and Montgomery Counties only), D.C. and VA residents
Disability Certification
Advanced Directive Information Sheet
Maryland Advance Directive
Transition of Care