BlueMedicare Complete (HMO D-SNP)

2022 Summary of Benefits

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

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

Summary of Benefits - Charlotte, Clay, Collier, Duval, Hernando, Lee, Manatee, Marion, Pasco, Pinellas, Sarasota (PDF)

 

2022 Evidence of Coverage

Evidence of Coverage - Miami-Dade (PDF)

Evidence of Coverage - Broward, Palm Beach, St Lucie (PDF)

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

Evidence of Coverage - Hillsborough, Polk (PDF)

Evidence of Coverage - Clay, Duval, Marion (PDF)

Evidence of Coverage - Charlotte, Collier, Hernando, Lee, Manatee, Pasco, Pinellas, Sarasota (PDF)

 

2022 Annual Notice of Change

Annual Notice of Change - Miami-Dade (PDF)

Annual Notice of Change - Broward, Palm Beach (PDF)

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

Annual Notice of Change - Hillsborough, Polk (PDF)

Annual Notice of Change - Clay, Duval, Marion (PDF)

Annual Notice of Change - Collier, Hernando, Pasco, Pinellas (PDF)

 

2022 Comprehensive Formulary

Comprehensive Formulary - Brevard, Broward, Charlotte, Clay, Collier, Duval, Hernando, Hillsborough, Lake, Lee, Manatee, Marion, Miami-Dade, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Lucie, Sumter (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)

FBM FORM H1035
Last Updated: 10.01.2021
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