Medicare Advantage Dual Care Plan Documents
Find the documents you need to help you manage your Medicare Advantage prescription drug offered by Blue Cross and Blue Shield of Texas.
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Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)SM
2021 Annual Notice of Change Dual Care Plus (HMO SNP) English | español
2021 Evidence of Coverage Dual Care Plus (HMO SNP) English | español
2021 Summary of Benefits Dual Care Plus (DSNP) English | español
2021 Enrollment Form Dual Care Plus (HMO SNP) English | español
2021 Plan Star Rating - Plan too new to be measured
2021 Drug Formulary Dual Care Plus (HMO SNP) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (HMO SNP) English | español
2021 Prescription Drug Transition Policy (HMO SNP) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO SNP) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO SNP) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (DSNP)
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Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)SM
2022 Annual Notice of Change Dual Care Plus (HMO SNP) English | español
2022 Evidence of Coverage Dual Care Plus (HMO SNP) English | español
2022 Summary of Benefits Dual Care Plus (DSNP) English | español
2022 Enrollment Form Dual Care Plus (HMO SNP) English | español
2022 Plan Star Rating (HMO SNP) English | español
2022 Drug Formulary Dual Care Plus (HMO SNP) English | español
2022 Pharmacy Directory English | español
2022 Find a Doctor or Hospital English | español
2022 Low Income Premium Subsidy (HMO SNP) English | español
2022 Prescription Drug Transition Policy (HMO SNP) English | español
2022 Personal Medication List English | español
2022 Prescription Drug Coverage Determination Request Form (HMO SNP) English | español
2022 Online Coverage Determination Request Form
2022 Prescription Drug Coverage Redetermination Request Form (HMO SNP) English | español
2022 Online Coverage Redetermination Request Form
2022 Automated Premium Payment (ACH) Form (DSNP)
Last Updated: 09302021
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