Medicare Forms
2024 BlueMedicare Select (PPO)
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
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H5434-002 - Broward, Palm Beach, St. Lucie, Charlotte, Collier, Highlands, Hillsborough, Lee, Manatee, Pinellas, Orange, Osceola, Bay, Duval, Escambia, Marion, Santa Rosa
| 2024 Annual Notice of Changes | Last Updated |
|---|---|
| 2024 Annual Notice of Changes - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, St. Lucie and Santa Rosa | 9/18/2023 |
| 2024 Evidence of Coverage | Last Updated |
|---|---|
| 2024 Evidence of Coverage - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, St. Lucie and Santa Rosa | 9/18/2023 |
| 2024 Summary of Benefits | Last Updated |
|---|---|
| 2024 Summary of Benefits - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, St. Lucie and Santa Rosa | 9/18/2023 |
| 2024 Comprehensive Formulary | Last Updated |
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| 2024 Comprehensive Formulary - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, St. Lucie and Santa Rosa | 3/18/2024 |
| 2024 Enrollment Form | Last Updated |
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| 2024 Enrollment Form | 9/8/2023 |
| 2024 Medicare Star Rating | Last Updated |
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| 2024 Medicare Star Rating | 10/22/2023 |
| 2024 Prescription Drug Transition Policy | Last Updated |
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| 2024 Prescription Drug Transition Policy | 9/20/2023 |
| 2024 Low-Income Subsidy - Extra Help Program | Last Updated |
|---|---|
| 2024 Low-Income Subsidy - Extra Help Program | 9/11/2023 |