Medicare Forms
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BlueMedicare Classic Plus (HMO)
2023 Service Area
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H1035-046 - Citrus
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H1035-047 - Bay, Escambia, Okaloosa, Santa Rosa, Walton
Important 2023 benefit information, last updated 2/14/2023
BlueMedicare Classic Plus (HMO)
2023 Plan Documents
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
2023 Annual Notice of Changes
| Plan Document | Last Updated |
|---|---|
| 2023 Annual Notice of Changes - Citrus | last updated 9/19/2022 |
| 2023 Annual Notice of Changes - Bay, Escambia, Okaloosa, Santa Rosa | last updated 9/19/2022 |
2023 Evidence of Coverage
| Plan Document | Last Updated |
|---|---|
| 2023 Evidence of Coverage - Citrus | last updated 9/20/2022 |
| 2023 Evidence of Coverage - Bay, Escambia, Okaloosa, Santa Rosa, Walton | last updated 9/20/2022 |
2023 Summary of Benefits
| Plan Document | Last Updated |
|---|---|
| 2023 Summary of Benefits - Bay, Escambia, Okaloosa, Santa Rosa, Walton | last updated 8/23/2022 |
| 2023 Summary of Benefits - Citrus | last updated 8/23/2022 |
2023 Comprehensive Formulary
| Plan Document | Last Updated |
|---|---|
| 2023 Comprehensive Formulary | last updated 5/18/2023 |
2023 Enrollment Form
| Plan Document | Last Updated |
|---|---|
| 2023 Enrollment Form | last updated 8/5/2022 |
2023 Medicare Star Rating
| Plan Document | Last Updated |
|---|---|
| 2023 Medicare Star Rating | last updated 10/12/2022 |
2023 Prescription Drug Transition Policy
| Plan Document | Last Updated |
|---|---|
| 2023 Prescription Drug Transition Policy | last updated 7/1/2022 |
2023 Low-Income Subsidy - Extra Help Program
| Plan Document | Last Updated |
|---|---|
| 2023 Low-Income Subsidy - Extra Help Program | last updated 9/23/2022 |