Forms
The information below is presented in printer-friendly PDF format. 
Enrollment:
Please go to Apply for Insurance page before completing enrollment.
- MHIP Application Booklet
- MHIP Application
- MHIP+ Application
- Automatic Debit Form
- Qualifying Medical Conditions (page 4 of MHIP Application Booklet)
- Premium Rate Card (pages 12-15 of MHIP Application Booklet)
- Certificate of Coverage
- Enrollment Coverage Change Form
- Tier 4 Select Brand-Name Drug List
Privacy-Related:
Claim Form:
Resources
Viewing and printing these documents requires Adobe Acrobat Reader, which can be downloaded free from the Adobe site.
MHIP is administered by CareFirst BlueCross BlueShield and CareFirst BlueChoice, independent licensees of the BlueCross BlueShield Association.
