2021 Documents
View and download key forms and documents about your plan - including plan documents and forms for Medicare Advantage, Medicare Supplement and Prescription Drug plan members.
It seems you're using a browser version we no longer support. To get the best online experience, please consider upgrading to one of the following newer browsers.
Google Chrome Mozilla FireFox Apple Safari Microsoft Internet Explorer End of Message Box2020 Documents
View and download key forms and documents about your plan - including plan documents and forms for Medicare Advantage, Medicare Supplement and Prescription Drug plan members.
For more information on how to file a grievance, Click here.
Find forms and documents to help you manage your plan.
BlueMedicare Choice (Regional PPO)
BlueMedicare Complete Rx (PDP)
Find drug and/or utilization management information, drug forms and information, such as claim forms and formularies, on MyPrime.com. You will be asked a few questions so the site can determine which set of forms to show you.
Prior Authorization Criteria (PDF)
Important: If your prescription drug coverage is not from Florida Blue Medicare (through our pharmacy benefits manager, Prime Therapeutics), please contact your pharmacy benefits administrator for the forms you need.
Find forms and documents to help you manage your plan.
Automatic Payment Form - Medicare Supplement
Outline of Coverage Florida Blue Medicare Supplement Plans A, B, C, D, E, F, G, K, L, M, N
Medicare Supplement Plan Contract
Log in to your member account to see
your plan specific contract.
To view FHCP Medicare forms & documents click here
2021 Documents
View and download key forms and documents about your plan - including plan documents and forms for Medicare Advantage, Medicare Supplement and Prescription Drug plan members.
For more information on how to file a grievance, click here.
Find forms and documents to help you manage your plan.
BlueMedicare Complete (HMO D-SNP)
BlueMedicare Complete Rx (PDP)
Find drug and/or utilization management information, drug forms and information, such as claim forms and formularies, on MyPrime.com. You will be asked a few questions so the site can determine which set of forms to show you.
Important: If your prescription drug coverage is not from Florida Blue Medicare (through our pharmacy benefits manager, Prime Therapeutics), please contact your pharmacy benefits administrator for the forms you need.
Find forms and documents to help you manage your plan.
Automated Payment Form -
Medicare Supplement (PDF)
Take advantage of convenience security and savings with our Automatic Payment Option.
Outline of Coverage Florida Blue Medicare Supplement Plans A, B, C, D, E, F, G, K, L, M, N (PDF)
Medicare Supplement Plan Contract
Log in to your member account to see
your plan specific contract.
To view FHCP Medicare forms & documents click here