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 (HMO SNP)SM
2018 Annual Notice of Change (HMO SNP) English | español
2018 Evidence of Coverage (HMO SNP) English | español
2018 Summary of Benefits Dual Care (DSNP) English | español
2018 Enrollment Form Dual Care (HMO SNP) English | español
2018 Plan Star Rating (HMO SNP) English | español
2018 Drug Formulary (HMO SNP) English | español
2018 Pharmacy Directory (HMO SNP) English | español
2018 Provider Directory (HMO SNP) English | español
2018 Directory Online Request Form
2018 Low Income Premium Subsidy (HMO SNP) English | español
2018 Prescription Drug Transition Policy (HMO SNP) English | español
2018 Prescription Drug Coverage Determination Request Form (HMO SNP)
2018 Online Coverage Determination Request Form
2018 Prescription Drug Coverage Redetermination Request Form (HMO SNP)
2018 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Dual Care (HMO SNP)SM
2019 Annual Notice of Change (HMO SNP) English | español
2019 Evidence of Coverage (HMO SNP) English | español
2019 Summary of Benefits Dual Care (DSNP) English | español
2019 Enrollment Form Dual Care (HMO SNP) English | español
2018 Plan Star Rating (HMO SNP) English | español
2019 Drug Formulary (HMO SNP) English | español
2019 Pharmacy Directory (HMO SNP) English | español
2019 Provider Directory (HMO SNP) English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (HMO SNP) English | español
2019 Prescription Drug Transition Policy (HMO SNP) English | español
2019 Prescription Drug Coverage Determination Request Form (HMO SNP)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (HMO SNP)
2019 Online Coverage Redetermination Request Form
2019 Automated Premium Payment (ACH) Form (DSNP)
Last Updated: 09302018
Y0096_WEB_TX_MM19 Accepted
Last Updated: 09302018
Y0096_WEB_TX_MM19 Accepted