BlueMedicare Select (PPO)
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
2022 Summary of Benefits
Summary of Benefits - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (PDF), last updated 08/23/2021
2022 Evidence of Coverage
Evidence of Coverage - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (PDF), last updated 09/01/2021
2022 Annual Notice of Change
Annual Notice of Change - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (PDF), last updated 08/25/2021
2022 Comprehensive Formulary
Comprehensive Formulary - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie (PDF), last updated 05/15/2022
2022 Other Information & Documents
Enrollment Form (PDF), last updated 08/24/2021
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