HealthyBlue PPO Claim 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 Request
If you buy insurance through your employer, please contact your employer to make
changes. Changes will not be processed unless received from your employer. This
form is for D.C. and Maryland members only.
eBilling (Automatic Debit)
International Claim Form
(For care received out of network area)
Coordination of Benefits
(Update your information on My Account)
Disability Certification
Advanced Directive Information Sheet
Maryland Advance Directive
Transition of Care