Medicare Advantage Plan Documents
Find the documents you need to manage your Medicare Advantage Prescription Drug plan offered by Blue Cross and Blue Shield of Texas.
2021 Austin and Surrounding Areas
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Blue Cross Medicare Advantage Value (HMO)
2021 Austin Annual Notice of Change Value (HMO) English | español
2021 Austin Evidence of Coverage Value (HMO) English | español
2021 Austin Summary of Benefits Value (HMO) English | español
2021 Austin Enrollment Form (HMO) English | español
2021 Plan Star Rating English | español
2021 Drug Formulary Value (HMO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (HMO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Plus (PPO)
2021 Austin Annual Notice of Change Choice Plus (PPO) English | español
2021 Austin Evidence of Coverage Choice Plus (PPO) English | español
2021 Austin Summary of Benefits Choice Plus (PPO) English | español
2021 Plan Star Rating (PPO) English | español
2021 Enrollment Form (PPO) English | español
2021 Drug Formulary (PPO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (PPO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (PPO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Premier (PPO)
2021 Austin Annual Notice of Change Choice Premier (PPO) English | español
2021 Austin Evidence of Coverage Choice Premier (PPO) English | español
2021 Austin Summary of Benefits Choice Premier (PPO) English | español
2021 Plan Star Rating (PPO) English | español
2021 Enrollment Form (PPO) English | español
2021 Drug Formulary (PPO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (PPO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (PPO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
2021 Dallas and Surrounding Areas
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Blue Cross Medicare Advantage Value (HMO)
2021 Dallas Annual Notice of Change Value (HMO) English | español
2021 Dallas Evidence of Coverage Value (HMO) English | español
2021 Dallas Summary of Benefits Value (HMO) English | español
2021 Enrollment Form (HMO) English | español
2021 Plan Star Rating - Plan too new to be measured
2021 Drug Formulary (HMO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (HMO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Plus (PPO)
2021 Dallas Annual Notice of Change Choice Plus (PPO) English | español
2021 Dallas Evidence of Coverage Choice Plus (PPO) English | español
2021 Dallas Summary of Benefits Choice Plus (PPO) English | español
2021 Plan Star Rating (PPO) English | español
2021 Enrollment Form (PPO) English | español
2021 Drug Formulary (PPO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (PPO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (PPO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Premier (PPO)
2021 Dallas Annual Notice of Change Choice Premier (PPO) English | español
2021 Dallas Evidence of Coverage Choice Premier (PPO) English | español
2021 Dallas Summary of Benefits Choice Premier (PPO) English | español
2021 Plan Star Rating (PPO) English | español
2021 Enrollment Form (PPO) English | español
2021 Drug Formulary (PPO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (PPO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (PPO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
2021 El Paso and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2021 El Paso Annual Notice of Change Basic (HMO) English | español
2021 El Paso Evidence of Coverage Basic (HMO) English | español
2021 El Paso Summary of Benefits Basic (HMO) English | español
2021 Plan Star Rating (HMO) English | español
2021 El Paso Enrollment Form (HMO) English | español
2021 Drug Formulary Basic (HMO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (HMO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Value (HMO)
2021 Annual Notice of Change Value (HMO) English | español
2021 Evidence of Coverage Value (HMO) English | español
2021 Summary of Benefits Value (HMO) English | español
2021 Plan Star Rating (HMO) English | español
2021 Enrollment Form Value (HMO) English | español
2021 Drug Formulary Value (HMO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (HMO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Plus (PPO)
2021 El Paso Evidence of Coverage Choice Plus (PPO) English | español
2021 El Paso Summary of Benefits (PPO) English | español
2021 El Paso Enrollment Form (PPO) English | español
2021 Plan Star Rating (PPO) English | español
2021 Drug Formulary (PPO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (PPO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (PPO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
2021 Houston and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2021 Houston Annual Notice of Change Basic (HMO) English | español
2021 Houston Evidence of Coverage Basic (HMO) English | español
2021 Houston Summary of Benefits Basic (HMO) English | español
2021 Plan Star Rating (HMO) English | español
2021 Houston Enrollment Form (HMO) English | español
2021 Drug Formulary Basic (HMO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (HMO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Plus (PPO)
2021 Houston Annual Notice of Change Choice Plus (PPO) English | español
2021 Houston Evidence of Coverage Choice Plus (PPO) English | español
2021 Houston Summary of Benefits Choice Plus (PPO) English | español
2021 Plan Star Rating (PPO) English | español
2021 Enrollment Form (PPO) English | español
2021 Drug Formulary (PPO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (PPO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (PPO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Premier (PPO)
2021 Houston Annual Notice of Change Choice Premier (PPO) English | español
2021 Houston Evidence of Coverage Choice Premier (PPO) English | español
2021 Houston Summary of Benefits Choice Premier (PPO) English | español
2021 Plan Star Rating (PPO) English | español
2021 Enrollment Form (PPO) English | español
2021 Drug Formulary (PPO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (PPO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (PPO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
2021 San Antonio and Surrounding Areas
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Blue Cross Medicare Advantage Value (HMO)
2021 Annual Notice of Change Value (HMO) English | español
2021 Evidence of Coverage Value (HMO) English | español
2021 Summary of Benefits Value (HMO) English | español
2021 Plan Star Rating (HMO) English | español
2021 Enrollment Form Value (HMO) English | español
2021 Drug Formulary Value (HMO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (HMO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Plus (PPO)
2021 San Antonio Annual Notice of Change Choice Plus (PPO) English | español
2021 San Antonio Evidence of Coverage Choice Plus (PPO) English | español
2021 Summary of Benefits (PPO) English | español
2021 Plan Star Rating (PPO) English | español
2021 Enrollment Form (PPO) English | español
2021 Drug Formulary (PPO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (PPO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (PPO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
2021 South Texas and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2021 South Texas Annual Notice of Change Basic (HMO) English | español
2021 South Texas Evidence of Coverage Basic (HMO) English | español
2021 South Texas Summary of Benefits Basic (HMO) English | español
2021 Plan Star Rating (HMO) English | español
2021 South Texas Enrollment Form (HMO) English | español
2021 Drug Formulary Basic (HMO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (HMO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Value (HMO)
2021 Annual Notice of Change Value (HMO) English | español
2021 Evidence of Coverage Value (HMO) English | español
2021 Summary of Benefits Value (HMO) English | español
2021 Plan Star Rating (HMO) English | español
2021 Enrollment Form Value (HMO) English | español
2021 Drug Formulary Value (HMO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (HMO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Plus (PPO)
2021 South Texas Evidence of Coverage Choice Plus (PPO) English | español
2021 South Texas Summary of Benefits (PPO) English | español
2021 Plan Star Rating (PPO) English | español
2021 South Texas Enrollment Form (PPO) English | español
2021 Drug Formulary (PPO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (PPO) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (PPO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
2022 Austin Area
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Blue Cross Medicare Advantage Value (HMO)SM
2022 Austin Annual Notice of Change Value (HMO) English | español
2022 Austin Evidence of Coverage Value (HMO) English | español
2022 Austin Summary of Benefits Value (HMO) English | español
2022 Austin Enrollment Form (HMO) English | español
2022 Drug Formulary Value (HMO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (HMO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (HMO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Plus (PPO)SM
2022 Austin Annual Notice of Change Choice Plus (PPO) English | español
2022 Austin Evidence of Coverage Choice Plus (PPO) English | español
2022 Austin Summary of Benefits Choice Plus (PPO) English | español
2022 Austin Enrollment Form (PPO) English | español
2022 Drug Formulary Choice Plus (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Premier (PPO)SM
2022 Austin Annual Notice of Change Choice Premier (PPO) English | español
2022 Austin Evidence of Coverage Choice Plus (PPO) English | español
2022 Austin Summary of Benefits Choice Premier (PPO) English | español
2022 Austin Enrollment Form (PPO) English | español
2022 Drug Formulary Choice Premier (PPO) English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Classic (PPO)SM
2022 Austin Evidence of Coverage Classic (PPO)
Bell – English | español
Travis – English | español
2022 Austin Summary of Benefits Classic (PPO)
Bell – English | español
Travis – English | español2022 Austin Enrollment Form (PPO)
Bell – English | español
Travis – English | español2022 Austin Optional Supplemental Benefits Enrollment Form (PPO)
Bell – English | español
Travis – English | español
Current members should download, complete and submit this form to opt in for buy-up options.2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Classic (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Flex (PPO)SM
2022 Evidence of Coverage Flex (PPO) English | español
2022 Summary of Benefits Flex (PPO) English | español
2022 Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Flex (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
2022 Central Texas Area
(includes Bryan, San Angelo, Temple, Waco)
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Blue Cross Medicare Advantage Classic (PPO)SM
2022 Central Evidence of Coverage Classic (PPO)
Archer – English | español
Bell – English | español
Bexar – English | español
Brazoria – English | español2022 Central Summary of Benefits Classic (PPO)
Archer – English | español
Bell – English | español
Bexar – English | español
Brazoria – English | español2022 Central Enrollment Form (PPO)
Archer – English | español
Bell – English | español
Bexar – English | español
Brazoria – English | español2022 Central Optional Supplemental Benefits Enrollment Form (PPO)
Archer – English | español
Bell – English | español
Bexar – English | español
Brazoria – English | español
Current members should download, complete and submit this form to opt in for buy-up options.2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Classic (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Flex (PPO)SM
2022 Evidence of Coverage Flex (PPO) English | español
2022 Summary of Benefits Flex (PPO) English | español
2022 Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Flex (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
2022 Dallas Area
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Blue Cross Medicare Advantage Value (HMO)SM
2022 Dallas Annual Notice of Change Value (HMO) English | español
2022 Dallas Evidence of Coverage Value (HMO) English | español
2022 Dallas Summary of Benefits Value (HMO) English | español
2022 Dallas Enrollment Form (HMO) English | español
2022 Drug Formulary Value (HMO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (HMO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (HMO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Plus (PPO)SM
2022 Dallas Annual Notice of Change Choice Plus (PPO) English | español
2022 Dallas Evidence of Coverage Choice Plus (PPO) English | español
2022 Dallas Summary of Benefits Choice Plus (PPO) English | español
2022 Dallas Enrollment Form (PPO) English | español
2022 Drug Formulary Choice Plus (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Premier (PPO)SM
2022 Dallas Annual Notice of Change Choice Premier (PPO) English | español
2022 Dallas Evidence of Coverage Choice Premier (PPO) English | español
2022 Dallas Summary of Benefits Choice Premier (PPO) English | español
2022 Dallas Enrollment Form (PPO) English | español
2022 Drug Formulary Choice Premier (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Classic (PPO)SM
2022 Dallas Evidence of Coverage Classic (PPO)
Archer – English | español
Bell – English | español
Denton – English | español
Freestone – English | español2022 Dallas Summary of Benefits Classic (PPO)
Archer – English | español
Bell – English | español
Denton – English | español
Freestone – English | español2022 Dallas Enrollment Form (PPO)
Archer – English | español
Bell – English | español
Denton – English | español
Freestone – English | español2022 Dallas Optional Supplemental Benefits Enrollment Form (PPO)
Archer – English | español
Bell – English | español
Denton – English | español
Freestone – English | español
Current members should download, complete and submit this form to opt in for buy-up options.2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Classic (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Flex (PPO)SM
2022 Evidence of Coverage Flex (PPO) English | español
2022 Summary of Benefits Flex (PPO) English | español
2022 Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Flex (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
2022 El Paso Area
-
Blue Cross Medicare Advantage Value (HMO)SM
2022 Annual Notice of Change Value (HMO) English | español
2022 Evidence of Coverage Value (HMO) English | español
2022 Summary of Benefits Value (HMO) English | español
2022 Enrollment Form (HMO) English | español
2022 Drug Formulary Value (HMO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (HMO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (HMO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Choice Plus (PPO)SM
2022 El Paso Annual Notice of Change Choice Plus (PPO) English | español
2022 El Paso Evidence of Coverage Choice Plus (PPO) English | español
2022 El Paso Summary of Benefits Choice Plus (PPO) English | español
2022 El Paso Enrollment Form (PPO) English | español
2022 Drug Formulary Choice Plus (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Basic (HMO)SM
2022 El Paso Annual Notice of Change Basic (HMO) English | español
2022 El Paso Evidence of Coverage Basic (HMO) English | español
2022 El Paso Summary of Benefits Basic (HMO) English | español
2022 El Paso Enrollment Form (HMO) English | español
2022 Drug Formulary Basic (HMO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Classic (PPO)SM
2022 El Paso Evidence of Coverage Classic (PPO) English | español
2022 El Paso Summary of Benefits Classic (PPO) English | español
2022 El Paso Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Classic (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Flex (PPO)SM
2022 Evidence of Coverage Flex (PPO) English | español
2022 Summary of Benefits Flex (PPO) English | español
2022 Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Flex (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
2022 Houston Area
-
Blue Cross Medicare Advantage Basic (HMO)SM
2022 Houston Annual Notice of Change Basic (HMO) English | español
2022 Houston Evidence of Coverage Basic (HMO) English | español
2022 Houston Summary of Benefits Basic (HMO) English | español
2022 Houston Enrollment Form (HMO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Basic (HMO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (HMO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Choice Plus (PPO)SM
2022 Houston Annual Notice of Change Choice Plus (PPO) English | español
2022 Houston Evidence of Coverage Choice Plus (PPO) English | español
2022 Houston Summary of Benefits Choice Plus (PPO) English | español
2022 Houston Enrollment Form (PPO) English | español
2022 Drug Formulary Choice Plus (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Choice Premier (PPO)SM
2022 Houston Annual Notice of Change Choice Premier (PPO) English | español
2022 Houston Evidence of Coverage Choice Plus (PPO) English | español
2022 Houston Summary of Benefits Choice Premier (PPO) English | español
2022 Houston Enrollment Form (PPO) English | español
2022 Drug Formulary Choice Premier (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Classic (PPO)SM
2022 Houston Evidence of Coverage Classic (PPO)
Beaumont and Galveston – English | español
Bell – English | español
Brazoria – English | español
Freestone – English | español2022 Houston Summary of Benefits Classic (PPO)
Beaumont and Galveston – English | español
Bell – English | español
Brazoria – English | español
Freestone – English | español2022 Houston Enrollment Form (PPO)
Beaumont and Galveston – English | español
Bell – English | español
Brazoria – English | español
Freestone – English | español2022 Houston Optional Supplemental Benefits Enrollment Form (PPO)
Beaumont and Galveston – English | español
Bell – English | español
Brazoria – English | español
Freestone – English | español
Current members should download, complete and submit this form to opt in for buy-up options.2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Classic (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Flex (PPO)SM
2022 Evidence of Coverage Flex (PPO) English | español
2022 Summary of Benefits Flex (PPO) English | español
2022 Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Flex (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Value (HMO)SM
2022 Houston Evidence of Coverage Value (HMO) English | español
2022 Houston Summary of Benefits Value (HMO) English | español
2022 Houston Enrollment Form (HMO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Value (HMO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (HMO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
2022 North Texas Area
(includes Bryan, Lawton, Temple, Waco, and Wichita Falls)
-
Blue Cross Medicare Advantage Classic (PPO)SM
2022 North Texas Evidence of Coverage Classic (PPO)
Archer – English | español
Bell – English | español
Brazoria – English | español2022 North Texas Summary of Benefits Classic (PPO)
Archer – English | español
Bell – English | español
Brazoria – English | español2022 North Texas Enrollment Form (PPO)
Archer – English | español
Bell – English | español
Brazoria – English | español2022 North Texas Optional Supplemental Benefits Enrollment Form (PPO)
Archer – English | español
Bell – English | español
Brazoria – English | español
Current members should download, complete and submit this form to opt in for buy-up options.2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Classic (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Flex (PPO)SM
2022 Evidence of Coverage Flex (PPO) English | español
2022 Summary of Benefits Flex (PPO) English | español
2022 Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Flex (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
2022 Northeast Texas Area
(includes Longview and Tyler)
-
Blue Cross Medicare Advantage Classic (PPO)SM
2022 Northeast Texas Evidence of Coverage Classic (PPO) English | español
2022 Northeast Texas Summary of Benefits Classic (PPO) English | español
2022 Northeast Texas Enrollment Form (PPO) English | español
2022 Northeast Texas Optional Supplemental Benefits Enrollment Form (PPO) English | español
Current members should download, complete and submit this form to opt in for buy-up options.2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Classic (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Flex (PPO)SM
2022 Evidence of Coverage Flex (PPO) English | español
2022 Summary of Benefits Flex (PPO) English | español
2022 Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Flex (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
2022 San Antonio Area
-
Blue Cross Medicare Advantage Value (HMO)SM
2022 Annual Notice of Change Value (HMO) English | español
2022 Evidence of Coverage Value (HMO) English | español
2022 Summary of Benefits Value (HMO) English | español
2022 Enrollment Form (HMO) English | español
2022 Drug Formulary Value (HMO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (HMO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (HMO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Choice Plus (PPO)SM
2022 San Antonio Annual Notice of Change Choice Plus (PPO) English | español
2022 San Antonio Evidence of Coverage Choice Plus (PPO) English | español
2022 San Antonio Summary of Benefits Choice Plus (PPO) English | español
2022 San Antonio Enrollment Form (PPO) English | español
2022 Drug Formulary Choice Plus (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Classic (PPO)SM
2022 San Antonio Evidence of Coverage Classic (PPO)
Bell – English | español
Bexar – English | español2022 San Antonio Summary of Benefits Classic (PPO)
Bell – English | español
Bexar – English | español2022 San Antonio Enrollment Form (PPO)
Bell – English | español
Bexar – English | español2022 San Antonio Optional Supplemental Benefits Enrollment Form (PPO)
Bell – English | español
Bexar – English | español
Current members should download, complete and submit this form to opt in for buy-up options.2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Classic (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Flex (PPO)SM
2022 Evidence of Coverage Flex (PPO) English | español
2022 Summary of Benefits Flex (PPO) English | español
2022 Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Flex (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
2022 South Texas Area
(includes The Valley and Laredo)
-
Blue Cross Medicare Advantage Basic (HMO)SM
2022 South Texas Annual Notice of Change Basic (HMO) English | español
2022 South Texas Evidence of Coverage Basic (HMO) English | español
2022 South Texas Summary of Benefits Basic (HMO) English | español
2022 South Texas Enrollment Form (HMO) English | español
2022 Drug Formulary Basic (HMO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Value (HMO)SM
2022 Annual Notice of Change Value (HMO) English | español
2022 Evidence of Coverage Value (HMO) English | español
2022 Summary of Benefits Value (HMO) English | español
2022 Enrollment Form (HMO) English | español
2022 Drug Formulary Value (HMO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (HMO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (HMO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Choice Plus (PPO)SM
2022 South Texas Annual Notice of Change Choice Plus (PPO) English | español
2022 South Texas Evidence of Coverage Choice Plus (PPO) English | español
2022 South Texas Summary of Benefits Choice Plus (PPO) English | español
2022 South Texas Enrollment Form (PPO) English | español
2022 Drug Formulary Choice Plus (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Classic (PPO)SM
2022 South Texas Evidence of Coverage Classic (PPO)
Bee – English | español
Bexar – English | español2022 South Texas Summary of Benefits Classic (PPO)
Bee – English | español
Bexar – English | español2022 South Texas Enrollment Form (PPO)
Bee – English | español
Bexar – English | español2022 South Texas Optional Supplemental Benefits Enrollment Form (PPO)
Bee – English | español
Bexar – English | español
Current members should download, complete and submit this form to opt in for buy-up options.2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Classic (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
-
Blue Cross Medicare Advantage Flex (PPO)SM
2022 Evidence of Coverage Flex (PPO) English | español
2022 Summary of Benefits Flex (PPO) English | español
2022 Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Flex (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
2022 Southeast Texas Area
-
Blue Cross Medicare Advantage Classic (PPO)SM
2022 Southeast Texas Evidence of Coverage Classic (PPO) English | español
2022 Southeast Texas Summary of Benefits Classic (PPO) English | español
2022 Southeast Texas Enrollment Form (PPO) English | español
2022 Southeast Texas Optional Supplemental Benefits Enrollment Form (PPO) English | español
Current members should download, complete and submit this form to opt in for buy-up options.2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Classic (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Flex (PPO)SM
2022 Evidence of Coverage Flex (PPO) English | español
2022 Summary of Benefits Flex (PPO) English | español
2022 Enrollment Form (PPO) English | español
2022 Plan Star Rating — Plan too new to be measured
2022 Drug Formulary Flex (PPO) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (PPO) English | español
2022 Prescription Drug Transition Policy (MAPD) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (PPO) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (MAPD)
Last Updated: 09302021
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