BlueMedicare Value (PPO)

2021 Summary of Benefits

Summary of Benefits - Pinellas / Hernando, Pasco (PDF)

Summary of Benefits - Escambia, Okaloosa, Santa Rosa / Clay, Duval (PDF)

Summary of Benefits - Manatee, Sarasota / Charlotte, Collier, Lee (PDF)

Summary of Benefits - Broward, Indian River, Martin, Palm Beach, St. Lucie / Miami-Dade (PDF)

Summary of Benefits - Brevard, Orange, Osceola, Seminole / Hillsborough, Polk (PDF)

Summary of Benefits - Lake, Marion, Sumter (PDF)


2021 Evidence of Coverage
Evidence of Coverage - Pinellas (PDF)

Evidence of Coverage - Manatee, Sarasota (PDF)

Evidence of Coverage - Escambia, Okaloosa, Santa Rosa (PDF)

Evidence of Coverage - Broward, Indian River, Martin, Palm Beach, St. Lucie (PDF)

Evidence of Coverage - Charlotte, Collier, Lee (PDF)

Evidence of Coverage - Clay, Duval (PDF)

Evidence of Coverage - Miami-Dade (PDF)

Evidence of Coverage - Brevard, Orange, Osceola, Seminole (PDF)

Evidence of Coverage - Hillsborough, Polk (PDF)

Evidence of Coverage - Hernando, Pasco (PDF)

Evidence of Coverage - Lake, Marion, Sumter (PDF)


2021 Annual Notice of Change

Annual Notice of Change - Pinellas (PDF)

Annual Notice of Change - Manatee, Sarasota (PDF)

Annual Notice of Change - Escambia, Okaloosa, Santa Rosa (PDF)

Annual Notice of Change - Broward, Indian River, Martin, Palm Beach, St. Lucie (PDF)

Annual Notice of Change - Charlotte, Collier, Lee (PDF)

Annual Notice of Change - Clay, Duval (PDF)

Annual Notice of Change - Miami-Dade (PDF)

Annual Notice of Change - Brevard, Orange, Osceola, Seminole (PDF)

Annual Notice of Change - Hillsborough, Polk (PDF)

Annual Notice of Change - Hernando, Pasco (PDF)


2021 Comprehensive Formulary

Comprehensive Formulary - Miami-Dade (PDF)

Comprehensive Formulary - Pinellas / Manatee, Sarasota / Escambia, Okaloosa, Santa Rosa / Broward, Indian River, Martin, Palm Beach, St. Lucie / Charlotte, Collier, Lee / Clay, Duval / Brevard, Orange, Osceola, Seminole / Hillsborough, Polk / Hernando, Pasco / Lake, Marion, Sumter (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)