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BlueMedicare Classic Plus (HMO)

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

2022 Summary of Benefits

Summary of Benefits - Bay, Escambia, Okaloosa, Santa Rosa, Walton (PDF), last updated 08/24/2021

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

 

2022 Evidence of Coverage

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

Evidence of Coverage - Bay, Escambia, Okaloosa, Santa Rosa, Walton (PDF), last updated 08/27/2021

 

2022 Comprehensive Formulary

Comprehensive Formulary - Bay, Citrus, Escambia, Okaloosa, Santa Rosa (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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