2022 Summary of Benefits
Summary of Benefits - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (PDF)
2022 Evidence of Coverage
Evidence of Coverage - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (PDF)
2022 Annual Notice of Change
Annual Notice of Change - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (PDF)
2022 Comprehensive Formulary
Comprehensive Formulary - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (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 - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (PDF)
2021 Evidence of Coverage
Evidence of Coverage - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (PDF)
2021 Annual Notice of Change
Annual Notice of Change - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (PDF)
2021 Comprehensive Formulary
Comprehensive Formulary - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (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 BMS PPO 003 NF 102021
Last Updated: 10.01.2021
Y0011_FBM1080