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BlueMedicare Patriot (PPO)

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

2022 Summary of Benefits

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

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

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

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

Summary of Benefits - Lake, Marion, Sumter (PDF), last updated 08/24/2021

 

2022 Evidence of Coverage

Evidence of Coverage - Lake, Marion, Sumter (PDF), last updated 09/06/2021

Evidence of Coverage - Bay, Escambia, Okaloosa, Santa Rosa, Walton (PDF), last updated 09/06/2021

Evidence of Coverage - Clay, Duval, Nassau, St. Johns (PDF), last updated 09/06/2021

Evidence of Coverage - Hillsborough, Pasco, Pinellas (PDF), last updated 09/06/2021

Evidence of Coverage - Brevard, Orange (PDF), last updated 09/06/2021

 

2022 Annual Notice of Change

Annual Notice of Change - Lake, Marion, Sumter (PDF), last updated 08/25/2021

 

2022 Other Information & Documents

Enrollment Form (PDF), last updated 08/24/2021

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

Service Area Map (PDF), last updated 10/012021

FBM FORM H5434
Last Updated: 10.01.2021
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