Florida Blue is a PPO, RPPO and Rx (PDP) Plan with a Medicare contract. Florida Blue Medicare is an HMO Plan with a Medicare contract. Enrollment in Florida Blue and Florida Blue Medicare depends on contract renewal.

We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. For more information visit floridablue.com/ndnotice.

Language assistance available: Español, Kreyol Ayisien, Tiếng Việt, Português, 中文, français, Tagalog, русский, العربية, italiano, Deutsche, 한국어, Polskie, Gujarati, ไทย, 日本語, فارسی

©2021 Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue. All rights reserved.

Blue365® offers access to savings on items that members may purchase directly from independent vendors. Blue365 does not include items covered under your policies with Blue Cross and Blue Shield of Florida or any applicable federal or health care program. To find out what is covered under your policies, call Florida Blue. Blue Cross and Blue Shield Association (BCBSA) and local Blue Companies may receive payments from Blue365 vendors. Neither BCBSA nor any local Blue company recommends, endorses, warrants or guarantees any specific Blue365 vendor or item.

HealthyBlue Rewards & Loyalty Program (HealthyBlue) restrictions and limitations may apply. See More

Florida Blue is a PPO, RPPO and Rx (PDP) Plan with a Medicare contract. Florida Blue Medicare is an HMO Plan with a Medicare contract. Enrollment in Florida Blue and Florida Blue Medicare depends on contract renewal.

For assistance, prospective Florida Blue members please call 1-855-601-9465 (TTY: 1-800-955-8770). Hours are 8 a.m. – 8 p.m., Monday – Friday. Florida Blue members please call 1-800-955-8770 (TTY: 1-800-955-8770). Hours are 8 a.m. - 8 p.m., local time, 7 days a week from October 1 - March 31, except for Thanksgiving and Christmas. From April 1 - September 30, we are open Monday - Friday, 8 a.m. - 8 p.m., local time.

Out-of-network/non-contracted providers are under no obligation to treat Florida Blue PPO members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Florida Blue DSNP plans are sponsored by Florida Blue Medicare, Inc., d/b/a Florida Blue Medicare, and the State of Florida, Agency for Health Care Administration.

This information is not a complete description of benefits. Call 1-855-601-9465 for more information. TTY users should call 1-800-955-8770.

Medicare beneficiaries may also enroll in Florida Blue Medicare plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

Every year, Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next.

If you speak Spanish, language assistance services, free of charge, are available to you. Call 1-800-926-6565 (TTY: 1-800-955-8770). Si habla español, hay servicios de traducción, libre de cargos, disponibles para usted. Llame al 1-800-926-6565 (TTY: 1-800-955-8773).

We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or or sex. For more information visit floridablue.com/ndnotice.

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-352-2583 (TTY: 1-877-955-8773). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-352-2583 (TTY: 1-800-955-8770).

Florida Blue Medicare P.O. Box 45296 Jacksonville, FL 32232-5296

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee of the Blue Cross and Blue Shield Association.

©2021 All Blue Cross and Blue Shield of Florida, Inc., dba Florida Blue. All rights reserved.

FHCP Medicare is an HMO Plan with a Medicare contract. Enrollment in FHCP Medicare depends on contract renewal.

For assistance, prospective FHCP Medicare members please call 1-855-462-3427 (TTY: 1-800-955-8770). Hours are 8 a.m. – 8 p.m. local time, seven days a week from October 1 – March 31, except for Thanksgiving and Christmas. From April 1 – September 30, we are open Monday – Friday, 8 a.m. – 8 p.m. local time.

This information is not a complete description of benefits. Call 1-855-462-3427 for more information. TTY users should call 1-800-955-8770.

FHCP Medicare’s pharmacy network includes limited lower-cost, preferred pharmacies in Brevard, Flagler, Seminole, St. Johns and Volusia counties, Florida. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-costs preferred pharmacies in your area, please call 1-855-462-3427 (TTY users call 1-800-955-8770) or consult the online pharmacy directory at www.fhcpmedicare.com.

Medicare beneficiaries may also enroll in FHCP Medicare plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

Every year, Medicare evaluates plans based on a 5-star rating system. Star ratings are calculated each year and may change from one year to the next.

FHCP Medicare P.O. Box 45296 Jacksonville, FL 32232-5296

HMO Coverage is offered by Florida Blue Medicare, Inc., DBA FHCP Medicare, an Independent Licensee of the Blue Cross and Blue Shield Association.

We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. For more information visit floridablue.com/ndnotice.

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee of the Blue Cross and Blue Shield Association.

BlueMedicare Supplement Plans C and F and BlueMedicare Supplement Select Plan C may not be offered to any newly eligible Medicare beneficiary. Newly eligible Medicare beneficiary means anyone who attains age 65 on or after January 1, 2020, or who first becomes eligible for Medicare benefits due to age, disability or end-stage renal disease on or after January 1, 2020.

Florida Blue Medicare Supplement Insurance policies are not connected with or endorsed by the U.S. Government or the Federal Medicare Program. The amount of benefits provided depends upon the plan selected and the premium may vary with the amount of benefits selected. While medical cost increases and inflation could increase our premiums, your premium will always remain the lowest we offer, according to your age at enrollment. Medical Underwriting will apply to all BlueMedicare Supplement and BlueMedicare Supplement Select products unless the applicant is eligible for guaranteed issue. Networks are comprised of independent contracting healthcare providers.

Policy Numbers: Policy Numbers: BlueMedicare Supplement Plan A – [30147-0717 SU] | BlueMedicare Supplement Select Plan B – [30166-0717 SU] | BlueMedicare Supplement Plan C – [30149-0717 SU] | BlueMedicare Supplement Plan D – [30150- 0717 SU] | BlueMedicare Supplement Plan F – [30151-0717 SU] | BlueMedicare Supplement Plan G – [30152-0717 SU] | BlueMedicare Supplement Plan K – [30154-0717 SU] | BlueMedicare Supplement - Plan L – [30155-0717 SU] | BlueMedicare Supplement Plan M – [30156-0717 SU] | BlueMedicare Supplement Plan N – [30157-0717 SU] | BlueMedicare Supplement Select Plan B – [30166-0717 SU] | BlueMedicare Supplement Select Plan C – [30167-0717 SU] | | BlueMedicare Supplement Select Plan D – [30168-0717 SU] | BlueMedicare Supplement Select Plan M – [30159-0717 SU]

If this policy is replacing current health insurance coverage that has been in effect for at least three months, there is no waiting period required for pre-existing conditions. However, if this policy does not replace current health insurance coverage, a condition treated three months before the effective date may not be covered until three months after the effective date of this policy. Additionally, coverage for this condition may not begin for patients in a hospital or skilled nursing facility the day before the effective date until they have been released, or six months passed the effective date of the policy. For special circumstances or questions, please call 1-855-601-9465 or TTY 1-800-955-8770.

BlueMedicare Supplement and BlueMedicare Supplement Select Plans are guaranteed renewable. Florida Blue will only terminate your coverage for nonpayment of premiums or material misrepresentation.

Exclusions for BlueMedicare Supplement and BlueMedicare Supplement Select Plans

Services or supplies not covered or approved by Medicare, and not considered eligible as a Medicare- Eligible Expense; Services or supplies in excess of what Medicare determines or would have determined is a covered Service and a Medicare-Eligible Expense; Services or supplies which would duplicate what Medicare has paid or would have paid had a claim for Services been submitted to Medicare; Services for which there is no charge or for which you have no legal liability to pay; Mental or nervous disorders, alcoholism and drug addiction in excess of what Medicare allows.; Illness, treatment or medical conditions arising out of: War or act of war (whether declared or undeclared); participation in a felony, riot or insurrection, engaging in an illegal occupation, service in the armed forces or auxiliary units thereto; suicide or attempted suicide, whether sane or insane, or intentionally self-inflicted injury; coverage for air related accidents which occur outside of the United States; being intoxicated or under the influence of any narcotic unless taken on the advice of a Physician; Cosmetic surgery, except that “cosmetic surgery” does not exclude benefits for reconstructive surgery when such Service is incidental to or follows surgery resulting from trauma, infection or other diseases of the involved part, or to restore normal bodily function; Hearing aids and eyeglasses and examinations for prescription fitting; Rest cures, custodial care, transportation and routine physical examinations.

These Plans do not contain limitations or exclusions on coverage that are more restrictive than those of Medicare.

The following exclusions apply ONLY to the plans indicated and not to other BlueMedicare Supplement or BlueMedicare Supplement Select plans:

  • Applies only to Plan A: Medicare Part A Inpatient deductible; Medicare Part B deductible; Care received outside of the United States.
  • Applies only to Plan A, Plan B and Select Plan B: Care received at a skilled nursing facility.
  • Applies only to Plan B, Select Plan B, Plan K and Plan L: Medicare Part B deductible; Care received outside of the United States.
  • Applies only to Plan C and Plan F: Care received outside of the United States that is not a Medically Necessary Medical Emergency/Accident Service.
  • Applies only to Plan D, Select Plan D, Plan G, Plan M Select Plan M, and Plan N: Medicare Part B deductible; Care received outside of the United States that is not a Medically Necessary Medical Emergency/Accident Service.

Applies only to BlueMedicare Select Plans:

  • Network Hospital - You are responsible for only 50% of the Medicare Part A deductible for each Medicare Benefit Period.
  • Non-Network Hospital, you are responsible for 100% of the inpatient Medicare Part A deductible EXCEPT as indicated in the Network Hospital Restrictions.

SilverSneakers is a separate fitness program and not part of Florida Blue’s Medicare Supplement Insurance Policy. To enroll in SilverSneakers, you must be enrolled in a Medicare Supplement Insurance Policy through Florida Blue. Your SilverSneakers fitness membership will automatically cancel when you are no longer enrolled in a Florida Blue Medicare Supplement Insurance policy. You may cancel your SilverSneakers membership at any time.

Tivity Health, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of Tivity Health, Inc. and/or its subsidiaries and/or affiliates in the USA and/or other countries. © 2021 Tivity Health, Inc. All rights reserved.

FBM DIS 001 F 122019
Last Updated: 10.01.2021
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