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.
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Blue Cross Medicare Advantage Value (HMO)
2018 Annual Notice of Change Value (HMO) English | español
2018 Evidence of Coverage Value (HMO) English | español
2018 Summary of Benefits Value and Select (HMO) English | español
2018 Enrollment Form Value (HMO) English | español
2018 Plan Star Rating Value (HMO) English | español
2018 Drug Formulary Value (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Provider Directory Value (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Select (HMO)
2018 Annual Notice of Change Select (HMO) English | español
2018 Evidence of Coverage Select (HMO) English | español
2018 Summary of Benefits Value and Select (HMO) English | español
2018 Enrollment Form Value and Select (HMO) English | español
2018 Plan Star Rating Value and Select (HMO) English | español
2018 Drug Formulary Value and Select (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Provider Directory Value and Select (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
2018 Austin and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2018 Austin Annual Notice of Change Basic (HMO) English | español
2018 Austin Evidence of Coverage Basic (HMO) English | español
2018 Austin Summary of Benefits Basic (HMO) English | español
2018 Austin Enrollment Form (HMO) English | español
2018 Plan Star Rating Basic (HMO) English | español
2018 Austin Drug Formulary Basic (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Provider Directory Basic (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Premier (HMO)
2018 Austin Annual Notice of Change Premier (HMO) English | español
2018 Austin Evidence of Coverage Premier (HMO) English | español
2018 Austin Summary of Benefits Premier (HMO) English | español
2018 Austin Enrollment Form (HMO) English | español
2018 Plan Star Rating Premier (HMO) English | español
2018 Austin Drug Formulary Premier (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Provider Directory Premier (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Choice Plus (PPO)
2018 Austin Annual Notice of Change Choice Plus (PPO) English | español
2018 Austin Evidence of Coverage Choice Plus (PPO) English | español
2018 Austin Summary of Benefits Choice Plus (PPO) English | español
2018 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2018 Drug Formulary (PPO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Austin Provider Directory (PPO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (PPO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Choice Premier (PPO)
2018 Austin Annual Notice of Change Choice Premier (PPO) English | español
2018 Austin Evidence of Coverage Choice Premier (PPO) English | español
2018 Austin Summary of Benefits Choice Premier (PPO) English | español
2018 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2018 Drug Formulary (PPO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Austin Provider Directory (PPO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (PPO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
2018 Dallas and Surrounding Areas
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Blue Cross Medicare Advantage Choice Plus (PPO)
2018 Dallas Annual Notice of Change Choice Plus (PPO) English | español
2018 Dallas Evidence of Coverage Choice Plus (PPO) English | español
2018 Dallas Summary of Benefits Choice Plus (PPO) English | español
2018 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2018 Drug Formulary (PPO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Dallas Provider Directory (PPO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (PPO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Choice Premier (PPO)
2018 Dallas Annual Notice of Change Choice Premier (PPO) English | español
2018 Dallas Evidence of Coverage Choice Premier (PPO) English | español
2018 Dallas Summary of Benefits Choice Premier (PPO) English | español
2018 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2018 Drug Formulary (PPO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Dallas Provider Directory (PPO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (PPO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
2018 El Paso and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2018 El Paso Annual Notice of Change Basic (HMO) English | español
2018 El Paso Evidence of Coverage Basic (HMO) English | español
2018 El Paso Summary of Benefits Basic (HMO) English | español
2018 El Paso Enrollment Form (HMO) English | español
2018 Plan Star Rating (HMO) English | español
2018 Drug Formulary (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/HMO) English | español
2018 Provider Directory (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Premier (HMO)
2018 El Paso Annual Notice of Change Premier (HMO) English | español
2018 El Paso Evidence of Coverage Premier (HMO) English | español
2018 El Paso Summary of Benefits Premier (HMO) English | español
2018 El Paso Enrollment Form (HMO) English | español
2018 Plan Star Rating Premier (HMO) English | español
2018 Drug Formulary Premier (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/HMO) English | español
2018 Provider Directory Premier (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Basic Plus (HMO POS)
2018 El Paso Annual Notice of Change Basic Plus (HMO) English | español
2018 El Paso Evidence of Coverage Basic Plus (HMO) English | español
2018 El Paso Summary of Benefits Basic Plus (HMO) English | español
2018 El Paso Enrollment Form (HMO) English | español
2018 Plan Star Rating Basic Plus (HMO) English | español
2018 Drug Formulary Basic Plus (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/HMO) English | español
2018 Provider Directory Basic Plus (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
2018 Houston and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2018 Houston Annual Notice of Change Basic (HMO) English | español
2018 Houston Evidence of Coverage Basic (HMO) English | español
2018 Houston Summary of Benefits Basic (HMO) English | español
2018 Houston Enrollment Form (HMO) English | español
2018 Plan Star Rating Basic (HMO) English | español
2018 Drug Formulary Basic (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/HMO) English | español
2018 Provider Directory Basic (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Premier (HMO)
2018 Houston Annual Notice of Change Premier (HMO) English | español
2018 Houston Evidence of Coverage Premier (HMO) English | español
2018 Houston Summary of Benefits Premier (HMO) English | español
2018 Houston Enrollment Form (HMO) English | español
2018 Plan Star Rating Premier (HMO) English | español
2018 Drug Formulary Premier (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/HMO) English | español
2018 Provider Directory Premier (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Basic Plus (HMO POS)
2018 Houston Annual Notice of Change Basic Plus (HMO) English | español
2018 Houston Evidence of Coverage Basic Plus (HMO) English | español
2018 Houston Summary of Benefits Basic Plus (HMO) English | español
2018 Houston Enrollment Form (HMO) English | español
2018 Plan Star Rating Basic Plus (HMO) English | español
2018 Drug Formulary Basic Plus (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/HMO) English | español
2018 Provider Directory Basic Plus (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Choice Plus (PPO)
2018 Houston Annual Notice of Change Choice Plus (PPO) English | español
2018 Houston Evidence of Coverage Choice Plus (PPO) English | español
2018 Houston Summary of Benefits (PPO) English | español
2018 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2018 Drug Formulary (PPO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Houston Provider Directory (PPO) English | español
2018 Dental, Hearing and Vision Provider Directories English
2018 Directory Online Request Form
2018 Low Income Subsidy Premium (MAPD) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Choice Premier (PPO)
2018 Houston Annual Notice of Change Choice Premier (PPO) English | español
2018 Houston Evidence of Coverage Choice Premier (PPO) English | español
2018 Houston Summary of Benefits Choice Premier (PPO) English | español
2018 Houston Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2018 Drug Formulary (PPO) English | español
2018 Pharmacy Directory (PPO/PPO-POS/PPO) English | español
2018 Houston Provider Directory (PPO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (PPO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
2018 San Antonio and Surrounding Areas
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Blue Cross Medicare Advantage Choice Plus (PPO)
2018 San Antonio Annual Notice of Change Choice Plus (PPO) English | español
2018 San Antonio Evidence of Coverage Choice Plus (PPO) English | español
2018 Summary of Benefits (PPO) English | español
2018 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2018 Drug Formulary Plus and Premier (PPO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 San Antonio Provider Directory (PPO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (PPO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Choice Premier (PPO)
2018 San Antonio Annual Notice of Change Choice Premier (PPO) English | español
2018 San Antonio Evidence of Coverage Choice Premier (PPO) English | español
2018 Summary of Benefits (PPO) English | español
2018 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2018 Drug Formulary Plus and Premier (PPO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 San Antonio Provider Directory (PPO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (PPO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
2018 South Texas and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2018 South Texas Annual Notice of Change Basic (HMO) English | español
2018 South Texas Evidence of Coverage Basic (HMO) English | español
2018 South Texas Summary of Benefits Basic (HMO) English | español
2018 South Texas Enrollment Form (HMO) English | español
2018 Plan Star Rating Basic (HMO) English | español
2018 Drug Formulary Basic (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Provider Directory Basic (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Premier (HMO)
2018 South Texas Annual Notice of Change Premier (HMO) English | español
2018 South Texas Evidence of Coverage Premier (HMO) English | español
2018 South Texas Summary of Benefits Premier (HMO) English | español
2018 South Texas Enrollment Form (HMO) English | español
2018 Plan Star Rating Premier (HMO) English | español
2018 Drug Formulary Premier (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Provider Directory Premier (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Basic Plus (HMO POS)
2018 South Texas Annual Notice of Change Basic Plus (HMO) English | español
2018 South Texas Evidence of Coverage Basic Plus (HMO) English | español
2018 South Texas Summary of Benefits Basic Plus (HMO) English | español
2018 South Texas Enrollment Form (HMO) English | español
2018 Plan Star Rating Basic Plus (HMO) English | español
2018 Drug Formulary Basic Plus (HMO) English | español
2018 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2018 Provider Directory Basic Plus (HMO) English | español
2018 Dental, Hearing and Vision Provider Directories
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO) English | español
2018 Prescription Drug Transition Policy (MAPD) English | español
2018 Prescription Drug Coverage Determination Request Form (MAPD)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (MAPD)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Value (HMO)
2019 Annual Notice of Change Value (HMO) English | español
2019 Evidence of Coverage Value (HMO) English | español
2019 Summary of Benefits Value (HMO) English | español
2019 Enrollment Form Value (HMO) English | español
2018 Plan Star Rating Value (HMO) English | español
2019 Drug Formulary Value (HMO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Provider Directory Value (HMO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (HMO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
2019 Austin and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2019 Austin Annual Notice of Change Basic (HMO) English | español
2019 Austin Evidence of Coverage Basic (HMO) English | español
2019 Austin Summary of Benefits Basic (HMO) English | español
2019 Austin Enrollment Form (HMO) English | español
2018 Plan Star Rating Basic (HMO) English | español
2019 Austin Drug Formulary Basic (HMO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Provider Directory Basic (HMO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (HMO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Choice Plus (PPO)
2019 Austin Annual Notice of Change Choice Plus (PPO) English | español
2019 Austin Evidence of Coverage Choice Plus (PPO) English | español
2019 Austin Summary of Benefits Choice Plus (PPO) English | español
2019 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2019 Drug Formulary (PPO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Provider Directory (PPO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (PPO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Choice Premier (PPO)
2019 Austin Annual Notice of Change Choice Premier (PPO) English | español
2019 Austin Evidence of Coverage Choice Premier (PPO) English | español
2019 Austin Summary of Benefits Choice Premier (PPO) English | español
2019 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2019 Drug Formulary (PPO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Austin Provider Directory (PPO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (PPO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
2019 Dallas and Surrounding Areas
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Blue Cross Medicare Advantage Choice Plus (PPO)
2019 Dallas Annual Notice of Change Choice Plus (PPO) English | español
2019 Dallas Evidence of Coverage Choice Plus (PPO) English | español
2019 Dallas Summary of Benefits Choice Plus (PPO) English | español
2019 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2019 Drug Formulary (PPO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Dallas 2019 Provider Directory (PPO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (PPO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
2019 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Premier (PPO)
2019 Dallas Annual Notice of Change Choice Premier (PPO) English | español
2019 Dallas Evidence of Coverage Choice Premier (PPO) English | español
2019 Dallas Summary of Benefits Choice Premier (PPO) English | español
2019 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2019 Drug Formulary (PPO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Dallas 2019 Provider Directory (PPO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (PPO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
2019 Automated Premium Payment (ACH) Form (MAPD)
2019 El Paso and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2019 El Paso Annual Notice of Change Basic (HMO) English | español
2019 El Paso Evidence of Coverage Basic (HMO) English | español
2019 El Paso Summary of Benefits Basic (HMO) English | español
2019 El Paso Enrollment Form (HMO) English | español
2018 Plan Star Rating Basic (HMO) English | español
2019 Drug Formulary Basic (HMO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Provider Directory Basic (HMO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (HMO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
2019 Houston and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2019 Houston Annual Notice of Change Basic (HMO) English | español
2019 Houston Evidence of Coverage Basic (HMO) English | español
2019 Houston Summary of Benefits Basic (HMO) English | español
2019 Houston Enrollment Form (HMO) English | español
2018 Plan Star Rating Basic (HMO) English | español
2019 Drug Formulary Basic (HMO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Provider Directory Basic (HMO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (HMO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
2019 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Plus (PPO)
2019 Houston Annual Notice of Change Choice Plus (PPO) English | español
2019 Houston Evidence of Coverage Choice Plus (PPO) English | español
2019 Houston Summary of Benefits Choice Plus (PPO) English | español
2019 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2019 Drug Formulary (PPO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Houston Provider Directory (PPO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (PPO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
2019 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Premier (PPO)
2019 Houston Annual Notice of Change Choice Premier (PPO) English | español
2019 Houston Evidence of Coverage Choice Premier (PPO) English | español
2019 Houston Summary of Benefits Choice Premier (PPO) English | español
2019 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2019 Drug Formulary (PPO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Houston Provider Directory (PPO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (PPO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
2019 Automated Premium Payment (ACH) Form (MAPD)
2019 San Antonio and Surrounding Areas
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Blue Cross Medicare Advantage Choice Plus (PPO)
2019 San Antonio Annual Notice of Change Choice Plus (PPO) English | español
2019 San Antonio Evidence of Coverage Choice Plus (PPO) English | español
2019 Summary of Benefits (PPO) English | español
2019 Enrollment Form (PPO) English | español
2018 Plan Star Rating (PPO) English | español
2019 Drug Formulary Plus and Premier (PPO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 San Antonio 2019 Provider Directory (PPO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (PPO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
2019 Automated Premium Payment (ACH) Form (MAPD)
2019 South Texas and Surrounding Areas
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Blue Cross Medicare Advantage Basic (HMO)
2019 South Texas Annual Notice of Change Basic (HMO) English | español
2019 South Texas Evidence of Coverage Basic (HMO) English | español
2019 South Texas Summary of Benefits Basic (HMO) English | español
2019 South Texas Enrollment Form (HMO) English | español
2018 Plan Star Rating Basic (HMO) English | español
2019 Drug Formulary Basic (HMO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Provider Directory Basic (HMO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (HMO) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
2019 Automated Premium Payment (ACH) Form (MAPD)
Last Updated: 09302018
Y0096_WEB_TX_MM19 Accepted
Last Updated: 09302018
Y0096_WEB_TX_MM19 Accepted