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BlueMedicare Value (PPO)

View and download important forms and documents about your BlueMedicare plan from Florida Blue.

2022 Summary of Benefits

Summary of Benefits - Pinellas (PDF), last updated 08/24/2021

Summary of Benefits - Hernando & Pasco (PDF), last updated 08/24/2021

Summary of Benefits - Bay, Escambia, Leon, Okaloosa, Santa Rosa, Walton (PDF), last updated 08/24/2021

Summary of Benefits - Clay, Duval, Nassau, St. Johns, Flagler, Volusia (PDF), last updated 08/24/2021

Summary of Benefits - Broward, Indian River, Martin, Miami-Dade, Palm Beach, St. Lucie (PDF), last updated 08/24/2021

Summary of Benefits - Highlands, Manatee, Sarasota (PDF), last updated 08/24/2021

Summary of Benefits - Charlotte, Collier, Lee (PDF), last updated 08/23/2021

Summary of Benefits - Brevard, Orange, Osceola, Seminole (PDF), last updated 08/24/2021

Summary of Benefits - Hillsborough, Polk (PDF), last updated 08/24/2021

Summary of Benefits - Lake, Marion, Sumter (PDF), last updated 08/24/2021

Summary of Benefits - Alachua, Citrus (PDF), last updated 08/24/2021

 

2022 Evidence of Coverage

Evidence of Coverage - Pinellas (PDF), last updated 09/06/2021

Evidence of Coverage - Highlands, Manatee, Sarasota (PDF), last updated 09/06/2021

Evidence of Coverage - Bay, Escambia, Leon, Okaloosa, Santa Rosa, Walton (PDF)

Evidence of Coverage - Broward, Indian River, Martin, Palm Beach, St. Lucie (PDF), last updated 09/06/2021

Evidence of Coverage - Charlotte, Collier, Lee (PDF), last updated 09/06/2021

Evidence of Coverage - Clay, Duval, Flagler, Nassau, St Johns, Volusia (PDF), last updated 09/06/2021

Evidence of Coverage - Miami-Dade (PDF), last updated 09/06/2021

Evidence of Coverage - Brevard, Orange, Osceola, Seminole (PDF), last updated 09/06/2021

Evidence of Coverage - Hillsborough, Polk (PDF), last updated 09/06/2021

Evidence of Coverage - Hernando, Pasco (PDF), last updated 09/06/2021

Evidence of Coverage - Lake, Marion, Sumter (PDF), last updated 09/06/2021

Evidence of Coverage - Alachua, Citrus (PDF), last updated 09/06/2021

 

2022 Annual Notice of Change

Annual Notice of Change - Pinellas (PDF), last updated 08/25/2021

Annual Notice of Change - Manatee, Sarasota (PDF), last updated 08/25/2021

Annual Notice of Change - Escambia, Okaloosa, Santa Rosa (PDF), last updated 08/25/2021

Annual Notice of Change - Broward, Indian River, Martin, Palm Beach, St. Lucie (PDF), last updated 08/25/2021

Annual Notice of Change - Charlotte, Collier, Lee (PDF), last updated 08/25/2021

Annual Notice of Change - Clay, Duval (PDF), last updated 08/25/2021

Annual Notice of Change - Miami-Dade (PDF), last updated 08/25/2021

Annual Notice of Change - Orange (PDF), last updated 08/25/2021

Annual Notice of Change - Hillsborough, Polk (PDF), last updated 08/25/2021

Annual Notice of Change - Hernando, Pasco (PDF), last updated 08/25/2021

Annual Notice of Change - Lake, Marion, Sumter (PDF), last updated 08/25/2021

 

2022 Comprehensive Formulary

Comprehensive Formulary – Alachua, Bay, Brevard, Broward, Charlotte, Citrus, Clay, Collier, Duval, Escambia, Flagler, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Leon, Manatee, Marion, Martin, Miami-Dade, Nassau, Orange, Osceola, Okaloosa, Palm Beach, Pasco, Pinellas, Polk, Santa Rosa, Sarasota, Seminole, St. Johns, St. Lucie, Sumter, Volusia, Walton (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

FBM FORM H5434
Last Updated: 10.01.2021
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