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Jacksonville Center
14 miles away
(904) 363-5870
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View and download important forms and documents about your BlueMedicare plan from Florida Blue.
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Call Member Services at 1-800-926-6565 (TTY 1-800-955-8770)
Hours: 8:00 a.m. to 8:00 p.m. local time, seven days a week, from October 1 through March 31, except for Thanksgiving and Christmas. From April 1 through September 30, our hours are 8:00 a.m. to 8:00 p.m. local time, Monday through Friday, except for major holidays.
2024 BlueMedicare Complete (HMO DSNP)
View and download important forms and documents about your BlueMedicare plan from Florida Blue.
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H1035-027 - Miami-Dade
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H1035-028 - Broward, Palm Beach, St. Lucie
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H1035-029 - Brevard, Lake, Orange, Osceola, Seminole, Sumter
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H1035-031 - Clay, Duval, Marion
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H1035-032 - Charlotte, Collier, Hernando, Lee, Manatee, Pasco, Pinellas, Sarasota
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H1035-050 - Escambia, Okaloosa, Santa Rosa, Walton
| 2024 Annual Notice of Changes | Last Updated |
|---|---|
| 2024 Annual Notice of Changes - Miami-Dade | 10/9/2023 |
| 2024 Annual Notice of Changes - Broward, Palm Beach and St. Lucie | 10/9/2023 |
| 2024 Annual Notice of Changes - Brevard, Lake, Orange, Osceola, Seminole and Sumter | 10/9/2023 |
| 2024 Annual Notice of Changes - Hillsborough and Polk | 10/9/2023 |
| 2024 Annual Notice of Changes - Clay, Duval and Marion | 10/9/2023 |
| 2024 Annual Notice of Changes - Charlotte, Collier, Hernando, Lee, Manatee, Pasco, Pinellas and Sarasota | 10/9/2023 |
| 2024 Annual Notice of Changes - Escambia, Okaloosa, Santa Rosa and Walton | 10/9/2023 |
| 2024 Evidence of Coverage | Last Updated |
|---|---|
| 2024 Evidence of Coverage - Miami-Dade | 10/4/2023 |
| 2024 Evidence of Coverage - Broward, Palm Beach and St. Lucie | 10/4/2023 |
| 2024 Evidence of Coverage - Brevard, Lake, Orange, Osceola, Seminole and Sumter | 10/4/2023 |
| 2024 Evidence of Coverage - Clay, Duval and Marion | 10/4/2023 |
| 2024 Evidence of Coverage - Charlotte, Collier, Hernando, Lee, Manatee, Pasco, Pinellas and Sarasota | 10/4/2023 |
| 2024 Evidence of Coverage - Escambia, Okaloosa, Santa Rosa and Walton | 10/4/2023 |
| 2024 Enrollment Form | Last Updated |
|---|---|
| 2024 Enrollment Form | 9/1/2023 |
| 2024 Medicare Star Rating | Last Updated |
|---|---|
| 2024Medicare Star Rating | 10/22/2023 |
| 2024 Prescription Drug Transition Policy | Last Updated |
|---|---|
| 2024 Prescription Drug Transition Policy | 09/20/2023 |
| 2024 Low-Income Subsidy - Extra Help Program | Last Updated |
|---|---|
| 2024 Low-Income Subsidy - Extra Help Program | 09/11/2023 |
FBM FORM NF
Disclaimers
Last Updated: 01.01.2024
Y0011_FBM1613_C
