Medicare Forms
2025 BlueMedicare Premier (HMO)
• H1035-022 - BlueMedicare Premier (HMO) - Palm Beach
• H1035-025 - BlueMedicare Premier (HMO) - Broward
• H1035-026 - BlueMedicare Premier (HMO) - Orange, Osceola
• H1035-033 - BlueMedicare Premier (HMO) - Clay, Duval
• H1035-034 - BlueMedicare Premier (HMO) - Hernando, Pinellas
• H1035-043 - BlueMedicare Premier (HMO) - Lake, Sumter, Marion
• H1035-045 - BlueMedicare Premier (HMO) - Charlotte, Collier, Lee, Manatee, Sarasota
• H1035-048 - BlueMedicare Premier (HMO) - Brevard, St. Lucie
• 2025 Annual Notice of Changes - Premier (HMO) - Palm Beach - last updated 8/23/24
• 2025 Annual Notice of Changes - Premier (HMO) - Hillsborough, Polk - last updated 8/23/24
• 2025 Annual Notice of Changes - Premier (HMO) - Broward - last updated 8/23/24
• 2025 Annual Notice of Changes - Premier (HMO) - Orange, Osceola - last updated 8/23/24
• 2025 Annual Notice of Changes - Premier (HMO) - Clay, Duval - last updated 8/23/24
• 2025 Annual Notice of Changes - Premier (HMO) - Hernando, Pinellas - last updated 8/23/24
• 2025 Annual Notice of Changes - Premier (HMO) - Lake, Marion, Sumter - last updated 8/23/24
• 2025 Annual Notice of Changes - Premier (HMO) - Charlotte, Collier, Lee, Manatee, Sarasota - last updated 8/23/24
• 2025 Annual Notice of Changes - Premier (HMO) - Brevard, St. Lucie - last updated 8/23/24
• 2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Palm Beach - last updated 9/3/24
• 2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Broward - last updated 9/3/24
• 2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Orange, Osceola - last updated 9/3/24
• 2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Clay, Duval - last updated 9/3/24
• 2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Hernando, Pinellas - last updated 9/3/24
• 2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Lake, Marion, Sumter - last updated 9/3/24
• 2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Charlotte, Collier, Lee, Manatee, Sarasota - last updated 9/3/24
• 2025 Evidence of Coverage - BlueMedicare Premier (HMO) - Brevard, St. Lucie - last updated 9/3/24
• 2025 Summary of Benefits - BlueMedicare Premier (HMO) - Palm Beach - last updated 8/22/24
• 2025 Summary of Benefits - BlueMedicare Premier (HMO) - Broward - last updated 8/22/24
• 2025 Summary of Benefits - BlueMedicare Premier (HMO) - Clay, Duval - last updated 8/22/24
• 2025 Summary of Benefits - BlueMedicare Premier (HMO) - Charlotte, Collier, Lee, Manatee, Sarasota - last updated 8/22/24
• 2025 Summary of Benefits - BlueMedicare Premier (HMO) - Brevard, St. Lucie - last updated 8/22/24
• 2025 Summary of Benefits - BlueMedicare Premier (HMO) - Orange, Osceola - last updated 8/22/24
• 2025 Summary of Benefits - BlueMedicare Premier (HMO) - Hernando, Pinellas - last updated 8/22/24
• 2025 Summary of Benefits - BlueMedicare Premier (HMO) - Lake, Marion, Sumter - last updated 8/22/24
• 2025 Enrollment Form - BlueMedicare Premier (HMO) - last updated 7/12/24
• 2025 Medicare Star Rating - BlueMedicare Premier (HMO) - last updated 10/16/24
• 2025 Formulary - BlueMedicare Premier (HMO) - last updated 10/15/2024
• 2025 Low Income Subsidy (LIS) - Extra Help Program - last updated 10/1/24
• 2025 Prescription Drug Transition Policy - last updated 8/14/24
2024 BlueMedicare Premier (HMO)
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
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H1035-022 - Palm Beach
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H1035-023 - Hillsborough, Polk
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H1035-024 - Miami-Dade
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H1035-025 - Broward
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H1035-026 - Orange, Osceola, Seminole
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H1035-033 - Clay, Duval
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H1035-034 - Hernando, Pasco, Pinellas
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H1035-043 - Lake, Marion, Sumter
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H1035-045 - Charlotte, Collier, Lee, Manatee, Sarasota
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H1035-048 - Brevard, St. Lucie
| 2024 Annual Notice of Changes | Last Updated |
|---|---|
| 2024 Annual Notice of Changes - Palm Beach | 10/9/2023 |
| 2024 Annual Notice of Changes - Hillsborough and Polk | 10/9/2023 |
| 2024 Annual Notice of Changes - Miami-Dade | 10/9/2023 |
| 2024 Annual Notice of Changes - Broward | 10/9/2023 |
| 2024 Annual Notice of Changes - Orange, Osceola and Seminole | 10/9/2023 |
| 2024 Annual Notice of Changes - Clay and Duval | 10/9/2023 |
| 2024 Annual Notice of Changes - Hernando, Pasco and Pinellas | 10/9/2023 |
| 2024 Annual Notice of Changes - Lake, Marion and Sumter | 10/9/2023 |
| 2024 Annual Notice of Changes - Charlotte, Collier, Lee, Manatee and Sarasota | 10/9/2023 |
| 2024 Annual Notice of Changes - Brevard and St. Lucie | 10/9/2023 |
| 2024 Evidence of Coverage | Last Updated |
|---|---|
| 2024 Evidence of Coverage - Palm Beach | 7/26/2024 |
| 2024 Evidence of Coverage - Hillsborough and Polk | 7/26/2024 |
| 2024 Evidence of Coverage - Miami-Dade | 7/26/2024 |
| 2024 Evidence of Coverage - Broward | 7/26/2024 |
| 2024 Evidence of Coverage - Orange, Osceola and Seminole | 7/26/2024 |
| 2024 Evidence of Coverage - Clay and Duval | 7/26/2024 |
| 2024 Evidence of Coverage - Hernando, Pasco and Pinellas | 7/26/2024 |
| 2024 Evidence of Coverage - Lake, Marion and Sumter | 7/26/2024 |
| 2024 Evidence of Coverage - Charlotte, Collier, Lee, Manatee and Sarasota | 7/26/2024 |
| 2024 Evidence of Coverage - Brevard and St. Lucie | 7/26/2024 |
| 2024 Summary of Benefits | Last Updated |
|---|---|
| 2024 Summary of Benefits - Miami-Dade | 9/18/2023 |
| 2024 Summary of Benefits - Palm Beach | 9/18/2023 |
| 2024 Summary of Benefits - Orange, Osceola and Seminole | 9/18/2023 |
| 2024 Summary of Benefits - Broward | 9/26/2023 |
| 2024 Summary of Benefits - Clay and Duval | 9/18/2023 |
| 2024 Summary of Benefits - Hillsborough and Polk | 9/18/2023 |
| 2024 Summary of Benefits - Hernando, Pasco and Pinellas | 9/18/2023 |
| 2024 Summary of Benefits - Charlotte, Collier, Lee, Manatee and Sarasota | 9/18/2023 |
| 2024 Summary of Benefits - Lake, Marion and Sumter | 9/18/2023 |
| 2024 Summary of Benefits - Brevard and St. Lucie | 9/18/2023 |
| 2024 Enrollment Form | Last Updated |
|---|---|
| 2024 Enrollment Form | 01/24/2024 |
| 2024 Medicare Star Rating | Last Updated |
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| 2024 Medicare Star Rating | 10/22/2023 |
| 2024 Prescription Drug Transition Policy | Last Updated |
|---|---|
| 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 |