Forms and applications

2020

• Maryland Application
• Virginia Application
• Maryland Change Form
• Maryland Grandfathered Change Form
• Virginia Change Form
• Maryland Application (Spanish)
• Virginia Application (Spanish)
• SEP guide
• SEP guide (Spanish)
• SEP Triggering Event form
• SEP Triggering Event form (Spanish)

2019

• KPIF Maryland Application
• KPIF Maryland Application (Spanish)
• KPIF Maryland Change Form
• KPIF Maryland Grandfathered Change Form
• KPIF SEP Triggering Event form
• KPIF SEP Triggering Event form (Spanish)
• KPIF Virginia Application
• KPIF Virginia Application (Spanish)
• KPIF Virginia Change Form

2021 Applications

• Maryland small group employer application
• Virginia small group employer application
• Maryland small group employee application
• Virginia small group employee application

2020 Applications

• Maryland small group employer application
• Virginia small group employer application
• Maryland small group employee application
• Virginia small group employee application

Electronic File Transfer Form for small groups

Employee forms 

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

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

• Incapacitated dependent form