Medicare Forms
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BlueMedicare Select (PPO)
2023 Service Area
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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
Important 2023 benefit information, last updated 2/14/2023
BlueMedicare Select (PPO)
2023 Plan Documents
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
2023 Annual Notice of Changes
| Plan Document | Last Updated |
|---|---|
| 2023 Annual Notice of Changes - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, St. Lucie, Santa Rosa | last updated 12/22/2022 |
2023 Evidence of Coverage
| Plan Document | Last Updated |
|---|---|
| 2023 Evidence of Coverage - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie | last updated 12/22/2022 |
2023 Summary of Benefits
| Plan Document | Last Updated |
|---|---|
| 2023 Summary of Benefits - Bay, Broward, Charlotte, Collier, Duval, Escambia, Highlands, Hillsborough, Lee, Manatee, Marion, Orange, Osceola, Palm Beach, Pinellas, Santa Rosa, St. Lucie | last updated 12/22/2022 |
2023 Comprehensive Formulary
| Plan Document | Last Updated |
|---|---|
| 2023 Comprehensive Formulary | last updated 5/18/2023 |
2023 Enrollment Form
| Plan Document | Last Updated |
|---|---|
| 2023 Enrollment Form | last updated 8/11/2022 |
2023 Medicare Star Rating
| Plan Document | Last Updated |
|---|---|
| 2023 Medicare Star Rating | last updated 10/12/2022 |
2023 Prescription Drug Transition Policy
| Plan Document | Last Updated |
|---|---|
| 2023 Prescription Drug Transition Policy | last updated 7/1/2022 |
2023 Low-Income Subsidy - Extra Help Program
| Plan Document | Last Updated |
|---|---|
| 2023 Low-Income Subsidy - Extra Help Program | last updated 9/23/2022 |