Small Business

Employer Forms

Maryland small group employer application - 2021
Virginia small group employer application - 2021

Employee Forms

Maryland small group employee application - 2021
Virginia small group employee application - 2021

Other Forms and Support

Electronic File Transfer Form for small groups
Incapacitated dependent form

Large Business

Employer Forms

DC, MD, and VA MID/LARGE employer application for groups of 51 or more employees
Risk questionnaire must be completed along with the DC, MD, and VA MID/LARGE employer application 

Employee Forms

DC, MD, and VA MID/LARGE employee enrollment or change form for groups of 51 or more employees

Other Forms and Support

Incapacitated dependents form (PDF)

Forms for all groups

Individual and Family

Application

Maryland Application - 2021
Virginia Application - 2021

SEP

SEP Triggerd Event Form -2021

Other Forms and Support

Incapacitated dependent form