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Carefirst termination form

Carefirst termination form 2025

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The document is an Individual Insurance Coverage Termination Form for subscribers in Maryland, Washington D.C., and Northern Virginia. It outlines the process for canceling health insurance coverage, including required subscriber information, reasons for termination, and instructions for submission. The form cannot be used for employer-based coverage or certain exchange plans. It also includes guidelines on effective dates, retroactive terminations, and language assistance services.

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Click ‘Get Form’ to open the carefirst termination form in the editor.
Begin with SECTION 1: SUBSCRIBER INFORMATION. Fill in your last name, first name, middle initial, residence address, county, city, state, ZIP code, and phone number.
Move to SECTION 2: PLAN INFORMATION. Enter your Subscriber ID (excluding the first three letters) and specify the requested date to terminate your plan. Select the plan(s) you wish to terminate by entering the corresponding group numbers for medical and dental coverage.
In SECTION 3: REASON FOR TERMINATION, choose a reason from the provided options. If applicable, include additional details in the 'Other' field.
Finally, complete SECTION 4 by signing and dating the form as the subscriber or legal guardian.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (216 Votes)
2018	4.3 Satisfied (126 Votes)
2017	4.4 Satisfied (183 Votes)
2014	4.3 Satisfied (58 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to file an appeal with CareFirst?

How to Appeal a Claim Step 1: Contact Us. Call the Member Services phone number on your member ID card. Step 2: Submit A Written Appeal. CareFirst BlueChoice must receive your written appeal within 180 days of the date of notification of the denial of benefits or services. Step 3: Appeal Decisions.

What is the phone number for CareFirst admin?

Please call CareFirst Provider Information and Credentialing at 410-872-3500 or 877-269-9593. You can also docHub out to your local Blue plan.

How to cancel Blue Shield medical insurance?

CareFirsts HMO plans use our BlueChoice network. Except for emergency services, if you go outside of the BlueChoice network, your medical services will not be covered. With our flexible regional BlueChoice Plus (POS) plans, your cost depends on which network you choose to receive services.

How do I cancel my CareFirst insurance?

How do I cancel my CareFirst health insurance? To close your account, call CareFirst customer support at Toll Free: 866-758-6119.

How do I cancel an insurance plan?

Member Questions? Please call CareFirst Administrators at 866-945-9839.

blue shield cancellation form

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What is the difference between CareFirst BCBS and BCBS?

BlueCross BlueShield is an association of ~44 regional plans. CareFirst is the licensee for Maryland, DC, and areas of Virginia bordering that.