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Questions? Call Member Services at 1-800-926-6565 (TTY 1-800-955-8770)

Hours: 8:00 a.m. to 8:00 p.m. local time, seven days a week, from October 1 through March 31, except for Thanksgiving and Christmas. From April 1 through September 30, our hours are 8:00 a.m. to 8:00 p.m. local time, Monday through Friday, except for major holidays.

View and download important forms and documents about your Florida Blue Medicare plan - including Medicare Advantage, Prescription Drug and Medicare Supplement plans.

Appeals & Grievances

  • Late Enrollment Penalty (LEP) Appeals

    Medicare beneficiaries may incur a late enrollment penalty (LEP) if there is a continuous period of 63 days or more at any time after the end of the individual's Part D initial enrollment period during which the individual was eligible to enroll but was not enrolled in a Medicare Part D plan and was not covered under any creditable prescription drug coverage.

    Information about LEP

    Information about LEP appeals

    LEP Appeal Form

  • Medicare Advantage (Part C): Appeals & Grievances

    You have the right to file a grievance or submit an appeal and ask us to review your coverage determination.

    How to file an Appeal or Grievance

    Appeals & Grievances Form

    Rights and Responsibilities upon Disenrollment: You have the right to ask us to reconsider this decision. You can ask us to reconsider by filing a grievance with us. You can look in your “Evidence of Coverage” for information about how to file a grievance, contact us at 1-800-926-6565 (TTY users: 1-800-955-8770) or click here for more information. Upon request, Medicare Advantage plans are required to disclose grievance and appeals data to Medicare Advantage enrollees in accordance with the regulatory requirements. You can contact us at 1-800-926-6565 (TTY users: 1-800-955-8770) to request this information.

  • Prescription Drug (Part D): Appeals & Grievances

    You have the right to file a grievance or submit an appeal and ask us to review your coverage determination.

    How to file an Appeal or Grievance

    Coverage Determination Form

    Coverage Redetermination Form

    Rights and Responsibilities upon Disenrollment: You have the right to ask us to reconsider this decision. You can ask us to reconsider by filing a grievance with us. You can look in your “Evidence of Coverage” for information about how to file a grievance, contact us at 1-800-926-6565 (TTY users: 1-800-955-8770) or click here for more information. Upon request, Prescription Drug plans are required to disclose grievance and appeals data to Prescription Drug enrollees in accordance with the regulatory requirements. You can contact us at 1-800-926-6565 (TTY users: 1-800-955-8770) to request this information.

  • Appoint a Representative

    You can appoint someone to act on your behalf. Go to Medicare.gov to download a form to Appointment of Representative.

    Go to Medicare.gov

  • Send a complaint to Medicare

    You can file a complaint about your Medicare health or drug plan. Go to Medicare.gov to file a Medicare Complaint Form.

    Go to Medicare.gov

Medicare Advantage Plans (Part C)

Prescription Drug Plans (Part D)

  • Prime Therapeutics

    Visit MyPrime.com to find prescription drug forms and information, such as claim forms, formularies, Prior Authorization Criteria, and Part D Step Therapy. You will be asked a few questions so the site can determine which set of forms to show you.

    Visit MyPrime.com

  • Medication Therapy Management Program (MTM)

    Visit the MTM Program page for Florida Blue members enrolled in stand-alone Medicare Prescription Drug (Part D) plans. 

    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

Take advantage of convenience security and savings with our Automatic Payment Option.

Medicare Supplement Plan Contract
Log in to your member account to see your plan specific contract.

To view FHCP Medicare forms & documents click here.

FBM FORM 001 F 032023
Last Updated: 02.20.2024
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