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BlueChoice HMO - Small Group On-SHOP Applications - Virginia
BlueChoice HMO (including HSA/HRA)
| Group Size | Group Subscriber Enrollment Form | Group Contract Application |
|---|---|---|
| 2-50 | SUM7310 (for plans effective between 1/1/26 and 12/31/26) SUM7768 (for plans effective 1/1/27 and after) |
VA-GRPAPP-HCR (R. 1-26)-HIX (for plans effective between 1/1/26 and 12/31/26) VA-GRPAPP-HCR (R. 1-27)-HIX (for plans effective 1/1/27 and after) |