The CareFirst Cancellation Form is for residents of Maryland, Washington D.C., and Northern Virginia who need to terminate their CareFirst individual health insurance coverage. It applies to medical, dental, and vision plans enrolled directly with CareFirst, not through the Federal Exchange, an employer group, or a government program.
To complete the form, you will need your Member ID number, subscriber name and date of birth, plan name, and reason for cancellation. Common reasons include transitioning to Medicare, a change in marital status, moving out of the covered region, or selecting a new plan during open enrollment. For retroactive cancellations due to a subscriber's death, additional documentation may be required.
Submit the form before the last day of the month to terminate coverage at month's end. CareFirst needs a few business days to process cancellation requests. Failing to pay premiums before submitting this form may affect the termination date. A termination request can be withdrawn, but only before CareFirst begins processing it.
| Question | Answer |
|---|---|
| Form Name | Carefirst Cancellation Form |
| Form Length | 6 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 30 sec |
| Other names | carefirst cancellation, carefirst insurance termination, carefirst reinstatement form, member cancellation form |
| States covered | Maryland, Washington D.C., Northern Virginia |
| Submission deadline | Last day of the month for month-end cancellation |
| Coverage types | Individual medical, dental, and vision plans |
