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.
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 Plan Star Rating (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 Plan Star Rating (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 Plan Star Rating (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 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)
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 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)
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 Plan Star Rating (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 Plan Star Rating (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 Plan Star Rating (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 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)
El Paso Area
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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 Plan Star Rating (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 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 Plan Star Rating (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 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 Plan Star Rating (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)
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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)
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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)
Houston Area
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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 (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 (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 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 Plan Star Rating (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 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 Plan Star Rating (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 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 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)
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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)
North Texas Area
(includes Bryan, Lawton, Temple, Waco, and Wichita Falls)
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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 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)
Northeast Texas Area
(includes Longview and Tyler)
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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 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)
San Antonio Area
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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 Plan Star Rating (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 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 Plan Star Rating (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 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 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)
South Texas Area
(includes The Valley and Laredo)
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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 Plan Star Rating (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 Plan Star Rating (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 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 Plan Star Rating (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 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)
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 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)
Last Updated: 09302021
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