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2024 BlueMedicare Value (PPO)

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

  • H5434-023 - Pinellas

  • H5434-024 - Highlands, Manatee, Sarasota

  • H5434-025 - Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton

  • H5434-026 - Broward, Indian River, Martin, Palm Beach, St. Lucie

  • H5434-030 - Charlotte, Collier, Lee

  • H5434-031 - Clay, Duval,  Nassau, St. Johns, Flagler, Volusia

  • H5434-032 - Miami-Dade

  • H5434-033 - Brevard, Orange, Osceola, Seminole

  • H5434-034 - Polk, Hillsborough

  • H5434-035 - Hernando, Pasco

  • H5434-036 - Lake, Sumter, Marion 

  • H5434-039 - Alachua, Citrus

2024 Annual Notice of Changes Last Updated
2024 Annual Notice of Changes - Pinellas 9/18/2023
2024 Annual Notice of Changes - Highlands, Manatee and Sarasota 9/18/2023
2024 Annual Notice of Changes - Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Walton and Wakulla 9/18/2023
2024 Annual Notice of Changes - Broward, Indian River, Martin, Palm Beach and St. Lucie 9/18/2023
2024 Annual Notice of Changes - Charlotte, Collier and Lee 9/18/2023
2024 Annual Notice of Changes - Clay, Duval, Flagler, Nassau, St. Johns and Volusia 9/18/2023
2024 Annual Notice of Changes - Miami-Dade 9/18/2023
2024 Annual Notice of Changes - Brevard, Orange, Osceola and Seminole 9/18/2023
2024 Annual Notice of Changes - Hillsborough and Polk 9/18/2023
2024 Annual Notice of Changes - Hernando and Pasco 9/18/2023
2024 Annual Notice of Changes - Lake, Marion and Sumter 9/18/2023
2024 Annual Notice of Changes - Alachua and Citrus 9/18/2023

 

2024 Evidence of Coverage Last Updated
2024 Evidence of Coverage - Pinellas 9/18/2023
2024 Evidence of Coverage - Highlands, Manatee and Sarasota 9/18/2023
2024 Evidence of Coverage - Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla and Walton 9/18/2023
2024 Evidence of Coverage - Broward, Indian River, Martin, Palm Beach and St. Lucie 9/18/2023
2024 Evidence of Coverage - Charlotte, Collier and Lee 9/18/2023
2024 Evidence of Coverage - Clay, Duval, Flagler, Nassau, St. Johns and Volusia 9/18/2023
2024 Evidence of Coverage - Miami-Dade 9/18/2023
2024 Evidence of Coverage - Brevard, Orange, Osceola and Seminole 9/18/2023
2024 Evidence of Coverage - Hillsborough and Polk 9/18/2023
2024 Evidence of Coverage - Hernando and Pasco 9/18/2023
2024 Evidence of Coverage - Lake, Marion and Sumter 9/18/2023
2024 Evidence of Coverage - Alachua and Citrus 9/18/2023

 

2024 Summary of Benefits Last Updated
2024 Summary of Benefits - Pinellas 9/18/2023
2024 Summary of Benefits - Highlands, Manatee and Sarasota 9/18/2023
2024 Summary of Benefits - Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla and Walton 9/18/2023
2024 Summary of Benefits - Broward, Indian River, Martin, Palm Beach and St. Lucie 9/18/2023
2024 Summary of Benefits - Charlotte, Collier and Lee 9/26/2023
2024 Summary of Benefits - Clay, Duval, Nassau and St. Johns 9/18/2023
2024 Summary of Benefits - Flagler and Volusia 9/18/2023
2024 Summary of Benefits - Miami-Dade 9/18/2023
2024 Summary of Benefits - Brevard, Orange, Osceola and Seminole 9/18/2023
2024 Summary of Benefits - Hillsborough and Polk 9/18/2023
2024 Summary of Benefits - Hernando and Pasco 9/18/2023
2024 Summary of Benefits - Lake, Marion and Sumter 9/18/2023
2024 Summary of Benefits - Alachua 9/18/2023
2024 Summary of Benefits - Citrus 9/18/2023

 

2024 Enrollment Form Last Updated
2024 Enrollment Form 9/8/2023

 

2024 Medicare Star Rating Last Updated
2024 Medicare Star Rating 10/12/2022

 

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

 

2023 BlueMedicare Value (PPO)

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

  • H5434-023 - Pinellas

  • H5434-024 - Highlands, Manatee, Sarasota

  • H5434-025 - Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton

  • H5434-026 - Broward, Indian River, Martin, Palm Beach, St. Lucie 

  • H5434-030 - Charlotte, Collier, Lee

  • H5434-031 - Clay, Duval,  Nassau, St. Johns, Flagler, Volusia

  • H5434-032 - Miami-Dade

  • H5434-033 - Brevard, Orange, Osceola, Seminole

  • H5434-034 - Polk, Hillsborough

  • H5434-035 - Hernando, Pasco

  • H5434-036 - Lake, Sumter, Marion

  • H5434-039 - Alachua, Citrus

Plan Document Last Updated
2023 Annual Notice of Changes - Pinellas last updated 9/19/2022
2023 Annual Notice of Changes - Highlands, Manatee, Sarasota last updated 9/19/2022
2023 Annual Notice of Changes - Bay, Escambia, Leon, Okaloosa, Santa Rosa and Walton last updated 9/19/2022
2023 Annual Notice of Changes - Broward, Indian River, Martin, Palm Beach, St. Lucie last updated 9/19/2022
2023 Annual Notice of Changes - Charlotte, Collier, Lee last updated 9/19/2022
2023 Annual Notice of Changes - Clay, Duval, Flagler, Nassau, St. Johns, Volusia last updated 9/19/2022
2023 Annual Notice of Changes - Miami-Dade last updated 9/19/2022
2023 Annual Notice of Changes - Brevard, Orange, Osceola, Seminole last updated 9/19/2022
2023 Annual Notice of Changes - Hillsborough, Polk last updated 9/19/2022
2023 Annual Notice of Changes - Hernando, Pasco last updated 9/19/2022
2023 Annual Notice of Changes - Lake, Marion, Sumter last updated 9/19/2022
2023 Annual Notice of Changes - Alachua, Citrus last updated 9/19/2022
Plan Document Last Updated
2023 Evidence of Coverage - Pinellas last updated 9/20/2022
2023 Evidence of Coverage - Highlands, Manatee, Sarasota last updated 9/20/2022
2023 Evidence of Coverage - Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton last updated 9/20/2022
2023 Evidence of Coverage - Broward, Indian River, Martin, Palm Beach, St. Lucie last updated 9/20/2022
2023 Evidence of Coverage - Charlotte, Collier, Lee last updated 9/20/2022
2023 Evidence of Coverage - Clay, Duval, Flagler, Nassau, St Johns, Volusia last updated 9/20/2022
2023 Evidence of Coverage - Miami-Dade last updated 9/20/2022
2023 Evidence of Coverage - Brevard, Orange, Osceola, Seminole last updated 9/20/2022
2023 Evidence of Coverage - Hillsborough, Polk last updated 9/20/2022
2023 Evidence of Coverage - Hernando, Pasco last updated 9/20/2022
2023 Evidence of Coverage - Lake, Marion, Sumter last updated 9/20/2022
2023 Evidence of Coverage - Alachua, Citrus last updated 9/20/2022
Plan Document Last Updated
2023 Summary of Benefits - Pinellas last updated 9/12/2022
2023 Summary of Benefits - Hernando, Pasco last updated 9/12/2022
2023 Summary of Benefits - Bay, Calhoun, Escambia, Franklin, Gadsden, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton last updated 9/12/2022
2023 Summary of Benefits - Clay, Duval, Flagler, Nassau, St. Johns, Volusia last updated 9/12/2022
2023 Summary of Benefits - Broward, Indian River, Martin, Palm Beach, St. Lucie, Miami-Dade last updated 9/12/2022
2023 Summary of Benefits - Highlands, Manatee, Sarasota, Charlotte, Collier, Lee last updated 9/12/2022
2023 Summary of Benefits - Brevard, Orange, Osceola, Seminole last updated 9/12/2022
2023 Summary of Benefits - Hillsborough, Polk last updated 9/12/2022
2023 Summary of Benefits - Lake, Marion, Sumter last updated 9/12/2022
2023 Summary of Benefits - Alachua, Citrus last updated 9/12/2022
Plan Document Last Updated
2023 Comprehensive Formulary last updated 9/20/2023
Plan Document Last Updated
2023 Enrollment Form last updated 8/11/2022
Plan Document Last Updated
2023 Medicare Star Rating last updated 10/12/2022
Plan Document Last Updated
2023 Prescription Drug Transition Policy last updated 7/1/2022
Plan Document Last Updated
2023 Low-Income Subsidy - Extra Help Program last updated 9/23/2022

Important 2023 benefit information, last updated 2/14/2023

FBM FORM NF
Disclaimers
Last Updated: 10.01.2023
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