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BlueMedicare Classic (HMO)

View and download important forms and documents about your BlueMedicare plan from Florida Blue.

2022 Summary of Benefits

Summary of Benefits - Miami-Dade (PDF), last updated 08/24/2021

Summary of Benefits - Palm Beach (PDF), last updated 08/24/2021

Summary of Benefits - Bay, Brevard, Charlotte, Collier, Escambia, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Santa Rosa, Sarasota, St. Johns, St. Lucie, Sumter (PDF), last updated 08/24/2021

Summary of Benefits - Citrus (PDF), last updated 08/24/2021

Summary of Benefits - Orange, Osceola, Seminole (PDF), last updated 08/24/2021

Summary of Benefits - Broward (PDF), last updated 08/24/2021

Summary of Benefits - Clay, Duval (PDF), last updated 08/24/2021

Summary of Benefits - Hernando, Hillsborough, Pasco, Polk (PDF), last updated 08/24/2021

 

2022 Evidence of Coverage

Evidence of Coverage - Miami-Dade (PDF), last updated 08/27/2021

Evidence of Coverage - Palm Beach (PDF), last updated 08/27/2021

Evidence of Coverage - Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Santa Rosa, Sarasota, St. Johns, St. Lucie, Sumter (PDF), last updated 08/27/2021

Evidence of Coverage - Orange, Osceola, Seminole (PDF), last updated 08/27/2021

Evidence of Coverage - Hernando, Hillsborough, Pasco, Polk (PDF), last updated 08/27/2021

 

2022 Annual Notice of Change

Annual Notice of Change - Miami-Dade (PDF), last updated 08/25/2021

Annual Notice of Change - Palm Beach (PDF), last updated 08/25/2021

Annual Notice of Change - Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Santa Rosa, Sarasota, St. Johns, St. Lucie, Sumter (PDF), last updated 08/25/2021

Annual Notice of Change - Orange, Osceola, Seminole (PDF), last updated 08/25/2021

Annual Notice of Change - Hernando, Hillsborough, Pasco, Polk (PDF), last updated 08/25/2021

 

2022 Comprehensive Formulary

Comprehensive Formulary - Miami-Dade (PDF), last updated 05/15/2022

Comprehensive Formulary - Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Hernando, Hillsborough, Lake, Lee, Manatee, Marion, Martin, Okaloosa, Orange, Osceola, Palm Beach, Pasco, Polk, Santa Rosa, Sarasota, Seminole, St. Johns, St. Lucie, Sumter (PDF), last updated 05/15/2022

 

2022 Other Information & Documents

Enrollment Form (PDF), last updated 07/30/2021

Medicare Star Rating (PDF), last updated 10/16/2021

Prescription Drug Transition Policy (PDF), last updated 07/01/2021

Low-Income Subsidy - Medicare Extra Help Program (PDF), last updated 09/01/2021

Service Area Map (PDF), last updated 10/01/2021

FBM FORM H1035
Last Updated: 10.01.2021
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