2022 Summary of Benefits
Summary of Benefits - Miami-Dade (PDF)
Summary of Benefits - Palm Beach (PDF)
Summary of Benefits - Orange, Osceola, Seminole (PDF)
Summary of Benefits - Broward (PDF)
Summary of Benefits - Clay, Duval (PDF)
Summary of Benefits - Hillsborough, Polk (PDF)
Summary of Benefits - Charlotte, Collier, Hernando, Lee, Manatee, Pasco, Pinellas, Sarasota (PDF)
Summary of Benefits - Lake, Marion, Sumter (PDF)
Summary of Benefits - Brevard, St. Lucie (PDF)
2022 Evidence of Coverage
Evidence of Coverage - Palm Beach (PDF)
Evidence of Coverage - Hillsborough, Polk (PDF)
Evidence of Coverage - Miami-Dade (PDF)
Evidence of Coverage - Broward (PDF)
Evidence of Coverage - Orange, Osceola, Seminole (PDF)
Evidence of Coverage - Clay, Duval (PDF)
Evidence of Coverage - Hernando, Pasco, Pinellas (PDF)
Evidence of Coverage - Charlotte, Collier, Lee, Manatee, Sarasota (PDF)
Evidence of Coverage -
Lake, Marion, Sumter (PDF)
Evidence of Coverage - Brevard, St. Lucie (PDF)
2022 Annual Notice of Change
Annual Notice of Change - Palm Beach (PDF)
Annual Notice of Change - Hillsborough, Polk (PDF)
Annual Notice of Change - Miami-Dade (PDF)
Annual Notice of Change - Broward (PDF)
Annual Notice of Change - Orange, Osceola (PDF)
Annual Notice of Change - Clay, Duval (PDF)
Annual Notice of Change - Hernando, Pasco, Pinellas (PDF)
Annual Notice of Change - Lake, Marion, Sumter (PDF)
Annual Notice of Change - Manatee, Sarasota (PDF)
2022 Comprehensive Formulary
Comprehensive Formulary - Brevard, Broward, Charlotte, Clay, Collier, Duval, Hernando, Hillsborough, Lake, Lee, Manatee, Marion, Miami-Dade, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie, Sumter (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 - Clay, Duval (PDF)
Summary of Benefits - Hillsborough, Polk (PDF)
Summary of Benefits - Miami-Dade (PDF)
Summary of Benefits - Orange, Osceola (PDF)
Summary of Benefits - Palm Beach (PDF)
Summary of Benefits - Hernando, Pasco, Pinellas / Manatee, Sarasota (PDF)
Summary of Benefits - Lake, Marion, Sumter (PDF)
Summary of Benefits - Broward (PDF)
2021 Evidence of Coverage
Evidence of Coverage - Palm Beach (PDF)
Evidence of Coverage - Hillsborough, Polk (PDF)
Evidence of Coverage - Miami-Dade (PDF)
Evidence of Coverage - Broward (PDF)
Evidence of Coverage - Orange, Osceola (PDF)
Evidence of Coverage - Clay, Duval (PDF)
Evidence of Coverage - Hernando, Pasco, Pinellas (PDF)
Evidence of Coverage - Lake, Marion, Sumter (PDF)
Evidence of Coverage - Manatee, Sarasota (PDF)
2021 Annual Notice of Change
Annual Notice of Change - Palm Beach (PDF)
Annual Notice of Change - Hillsborough, Polk (PDF)
Annual Notice of Change - Miami-Dade (PDF)
Annual Notice of Change - Broward (PDF)
Annual Notice of Change - Orange, Osceola (PDF)
Annual Notice of Change - Clay, Duval (PDF)
Annual Notice of Change - Hernando, Pasco, Pinellas (PDF)
2021 Comprehensive Formulary
Comprehensive Formulary - Palm Beach / Hillsborough, Polk / Miami-Dade / Broward / Orange, Osceola / Clay, Duval / Hernando, Pasco, Pinellas / Lake, Marion, Sumter / Manatee, Sarasota (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 BMP HMO 003 NF 102021
Last Updated: 10.01.2021
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