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View and download important forms and documents about your BlueMedicare plan from Florida Blue.
2022 Annual Notice of Changes - Broward, Palm Beach (PDF), last updated 08/25/2021
2022 Annual Notice of Changes - Hillsborough, Pinellas, Polk (PDF), last updated 08/25/2021
2022 Annual Notice of Changes - Orange, Osceola (PDF), last updated 08/25/2021
2022 Annual Notice of Changes - Miami-Dade (PDF), last updated 08/25/2021
2022 Evidence of Coverage - Broward, Palm Beach (PDF), last updated 08/28/2021
2022 Evidence of Coverage - Hillsborough, Pinellas, Polk (PDF), last updated 08/28/2021
2022 Evidence of Coverage - Orange, Osceola (PDF), last updated 08/28/2021
2022 Evidence of Coverage - Miami-Dade (PDF), last updated 08/28/2021
2022 Summary of Benefits - Broward, Miami-Dade, Palm Beach (PDF), last updated 08/23/2021
2022 Summary of Benefits - Hillsborough, Orange, Osceola, Pinellas, Polk (PDF), last updated 08/23/2021
2022 Comprehensive Formulary - Miami-Dade (PDF), last updated 09/15/2022
2022 Comprehensive Formulary - Broward, Hillsborough, Orange, Osceola, Palm Beach, Pinellas, Polk (PDF), last updated 09/15/2022
2022 Enrollment Form (PDF), last updated 07/30/2021
2022 Medicare Star Rating (PDF), last updated 10/16/2021
2022 Prescription Drug Transition Policy (PDF), last updated 07/01/2021
2022 Low-Income Subsidy - Medicare Extra Help Program (PDF), last updated 09/01/2021
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