| BlueChoice (HMO) |
| BlueChoice Opt-Out Open Access |
| BlueChoice Opt-Out Plus |
| BluePreferred |
| Catastrophic Health and Related Forms |
| HealthyBlue HMO |
| HealthyBlue 2.0 |
| HealthyBlue Plus |
| HealthyBlue Advantage |
| HealthyBlue PPO |
| HealthyBlue Dual/Triple Option |
| Maryland Point of Service (MPOS) |
| Personal Comp |
| Preferred Provider Organization (PPO) |
| Traditional Indemnity for NCA |
| Federal Employee Program For questions concerning your membership and benefits, or to obtain other FEP forms, contact Member Services at the telephone number on your ID card or visit www.fepblue.org. |
Change Healthcare notifying individuals of data breach. Learn more here.
Group Plan Medical Forms
These forms are to be used if you have a group plan you bought through your employer.
- If you are unsure of what 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.
Group Medical Plans
International Claim Form
Plan Termination
Proof of Coverage
Gender Services