BlueMedicare Complete Rx (PDP)

• 2022 Plan Documents

  2022 Summary of Benefits

  Summary of Benefits - Statewide (PDF)

  
  

  2022 Evidence of Coverage

  Evidence of Coverage - Statewide (PDF)

  
  

  2022 Annual Notice of Change

  Annual Notice of Change - Statewide (PDF)

  
  

  2022 Comprehensive Formulary

  Comprehensive Formulary - Statewide (PDF)

  
  

  2022 Other Information and Documents

  Enrollment Form (PDF)

  Service Area Map (PDF)

  Medicare Star Rating (PDF)

  Low-Income Subsidy - Medicare Extra Help Program (PDF)

  Prescription Drug Transition Policy (PDF)

• 2021 Plan Documents

  2021 Summary of Benefits

  Summary of Benefits - Statewide (PDF)

  
  

  2021 Evidence of Coverage

  Evidence of Coverage - Statewide (PDF)

  
  

  2021 Annual Notice of Change

  Annual Notice of Change - Statewide (PDF)

  
  

  2021 Comprehensive Formulary

  Comprehensive Formulary - Statewide (PDF)

  
  

  2021 Other Information and Documents

  Enrollment Form (PDF)

  Service Area Map (PDF)

  Medicare Star Rating (PDF)

  Low-Income Subsidy - Medicare Extra Help Program (PDF)

  Prescription Drug Transition Policy (PDF)

  
  
  
  
  FBM FORM BMCRX 003 NF 102021

  Disclaimers

  Last Updated: 10.01.2021
  Y0011_FBM1080