Medicare Forms
2024 BlueMedicare Classic Plus (HMO)
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
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H1035-046 - Citrus
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H1035-047 - Bay, Escambia, Okaloosa, Santa Rosa, Walton
| 2024 Annual Notice of Changes | Last Updated |
|---|---|
| 2024 Annual Notice of Changes - Citrus | 9/18/2023 |
| 2024 Annual Notice of Changes - Bay, Escambia, Okaloosa, Santa Rosa and Walton | 9/18/2023 |
| 2024 Evidence of Coverage | Last Updated |
|---|---|
| 2024 Evidence of Coverage - Citrus | 7/26/2024 |
| 2024 Evidence of Coverage - Bay, Escambia, Okaloosa, Santa Rosa and Walton | 7/26/2024 |
| 2024 Summary of Benefits | Last Updated |
|---|---|
| 2024 Summary of Benefits - Bay, Escambia, Okaloosa, Santa Rosa and Walton | 9/18/2023 |
| 2024 Summary of Benefits - Citrus | 9/18/2023 |
| 2024 Comprehensive Formulary | Last Updated |
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| 2024 Comprehensive Formulary - Bay, Citrus, Escambia, Okaloosa, Santa Rosa, Walton | 10/23/2024 |
| 2024 Enrollment Form | Last Updated |
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| 2024 Enrollment Form | 8/24/2023 |
| 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 |