Forms

The information below is presented in printer-friendly PDF format. PDF

Enrollment:

Please go to Apply for Insurance page before completing enrollment.

MHIP Application Booklet
MHIP Application
MHIP+ Application
MHIP+ Re-Certification Application
Automatic Debit Form
Qualifying Medical Conditions (page 4 of MHIP Application Booklet)
Premium Rate Card (page 11 of MHIP Application Booklet)
Certificate of Coverage
Enrollment Coverage Change Form

Privacy-Related:

Claim Form:

MHIP is administered by CareFirst BlueCross BlueShield and CareFirst BlueChoice, independent licensees of the BlueCross BlueShield Association.

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© Copyright 2007 Maryland Health Insurance Plan. All rights reserved

Maryland Health Insurance Plan (MHIP) is a state-managed health insurance program under the direction of the Board of Directors of the Maryland Health Insurance Plan. MHIP plans are administered by CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. This Web site is intended to summarize the Maryland Health Insurance Plan and does not replace legal requirements set forth in statutes, regulations or policies duly adopted by the Board of Directors of the Maryland Health Insurance Plan, which legally governs the operation of MHIP. If this Web site differs in any way from such legal requirements, the latter shall always govern.

CareFirst BlueCross BlueShield is the business name of Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association.

® Registered trademark of the Blue Cross and Blue Shield Association.
®' Registered trademark of CareFirst of Maryland, Inc.