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BlueMedicare Premier (Rx)

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

2022 Summary of Benefits

Summary of Benefits - Statewide (PDF), last updated 08/23/2021

 

2022 Evidence of Coverage

Evidence of Coverage - Statewide (PDF), last updated 08/24/2021

 

2022 Annual Notice of Change

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

 

2022 Comprehensive Formulary

Comprehensive Formulary - Statewide (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 S5904
Last Updated: 10.01.2021
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