BlueMedicare Saver (HMO)
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
2022 Summary of Benefits
Summary of Benefits - Broward, Miami-Dade, Palm Beach (PDF), last updated 08/23/2021
Summary of Benefits - Hillsborough, Orange, Osceola, Pinellas, Polk (PDF), last updated 08/23/2021
2022 Evidence of Coverage
Evidence of Coverage - Broward, Palm Beach (PDF), last updated 08/28/2021
Evidence of Coverage - Hillsborough, Pinellas, Polk (PDF), last updated 08/28/2021
Evidence of Coverage - Orange, Osceola (PDF), last updated 08/28/2021
Evidence of Coverage - Miami-Dade (PDF), last updated 08/28/2021
2022 Annual Notice of Change
Annual Notice of Change - Broward, Palm Beach (PDF), last updated 08/25/2021
Annual Notice of Change - Hillsborough, Pinellas, Polk (PDF), last updated 08/25/2021
Annual Notice of Change - Orange, Osceola (PDF), last updated 08/25/2021
Annual Notice of Change - Miami-Dade (PDF), last updated 08/25/2021
2022 Comprehensive Formulary
Comprehensive Formulary - Miami-Dade (PDF), last updated 05/15/2022
Comprehensive Formulary - Broward, Hillsborough, Orange, Osceola, Palm Beach, Pinellas, Polk (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