Publications

Group Hospitalization and Medical Services, Inc. Plans (Individual)

Proposed 2025 Rates
CareFirst

cfap-133618179_cfbc_individual_pls.pdf (141.51 KB)
CFAP-133624027 GHMSI Individual (2.93 MB)
CFAP-133624027 GHMSI Individual PLS (141.42 KB)
CFAP-134064986 - HMO_Individual (2.55 MB)
CFAP-134064986 - HMO_Individual_ConsumerNotice (221.75 KB)
CFAP 134065040 Individual PPO (2.6 MB)
CFAP 134065040 Individual PPO Consumer Notice (225.74 KB)

Captive Insurance Company Application

Instructions:

Captive Insurance Application (235.6 KB)
Captive Insurance Application - 06052020 (296.87 KB)
Captive Insurance Application (353.62 KB)

District Of Columbia Representative(s) Affidavit

District Of Columbia Representative(s) Affidavit

affidavit_representative_update_12_22_new.pdf (205.72 KB)
District Of Columbia Representative(s) Affidavit (182.69 KB)
District Of Columbia Representative(s) Affidavit (61.4 KB)

Surety Bond Form

Surety Bond Form

Surety Bond Form (47.16 KB)
Surety Bond Form (37.72 KB)
Surety Bond Form (37.69 KB)
Surety Bond Form-2019 (88.69 KB)

CareFirst BlueChoice, Inc. HMO (Small Group)

Proposed 2025 Rates
CareFirst

CFAP-133618363 CFBC Small Group (3.61 MB)
CFAP-133618363 CFBC Small Group PLS (141.35 KB)
CFAP-134065153 - SmallGroup_PPO_ConsumerNotice (141.33 KB)
CFAP-134065153 - SmallGroup_PPO (2.92 MB)
CFAP 134065116 Small Group HMO (5.56 MB)
CFAP 134065116 Small Group HMO Consumer Notice (142.1 KB)

Consumer Complaint Form

Please take the time to read these guidelines because following them will allow us to better serve you.

Consumer Complaint Form Mail-in Version (243.64 KB)
Consumer Complaint Form Mail-in Version (1.48 MB)
Consumer Complaint Form Mail-in Version (1.49 MB)
Queja para consumidor (104.79 KB)
Queja para consumidor (146.84 KB)
Consumer Complaint Form Mail-in Version (291.65 KB)

CareFirst BlueChoice, Inc. HMO (Individual)

Proposed 2025 Rates
CareFirst

CFAP-133618179 CFBC Individual (2.85 MB)
CFAP-133618179 CFBC Individual PLS (141.51 KB)
CFAP-134065040 - Individual_PPO (2.6 MB)
cfap-134064986-hmo_individual_consumer_notice.pdf (221.75 KB)
CFAP 134065040 Individual PPO Consumer Notice (225.74 KB)
CFAP 134065040 Individual PPO (2.6 MB)
CFAP-134064986 - HMO_Individual (2.55 MB)
CFAP-134064986 - HMO_Individual_ConsumerNotice (221.75 KB)

Uniform Consent to Service of Process - Form

Uniform Consent to Service of Process

Uniform Consent to Service of Process for Insurers.pdf (21.9 KB)

Worker’s Compensation Loss Cost Multipliers

Worker’s Compensation Loss Cost Multipliers

Worker’s Compensation Loss Cost Multipliers (195 KB)

DC Appleseed Letter - July 2013

DC Appleseed Letter - July 2013

DC Appleseed Letter - July 2013 (1.09 MB)

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