Blue Cross Medicare Advantage Dual Care (HMO SNP)SM Plan Documents | Blue Cross and Blue Shield of Texas

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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.

2020
2021

Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)^SM

2020 Evidence of Coverage Dual Care Plus (HMO SNP) English | español

2020 Summary of Benefits Dual Care Plus (DSNP) English | español

2020 Enrollment Form Dual Care Plus (HMO SNP) English | español

2020 Dual Care Plus Plan Star Rating (HMO SNP) English | español

2020 Drug Formulary Dual Care Plus (HMO SNP) English | español

2020 Find a Pharmacy English | español

2020 Find a Doctor or Hospital English | español

2020 Low Income Premium Subsidy (HMO SNP) English | español

2020 Prescription Drug Transition Policy (HMO SNP) English | español

2020 Prescription Drug Coverage Determination Request Form (HMO SNP)

2020 Online Coverage Determination Request Form

2020 Prescription Drug Coverage Redetermination Request Form (HMO SNP)

2020 Online Coverage Redetermination Request Form

2020 Automated Premium Payment (ACH) Form (DSNP)

2020 CMS Appointment of Representative Form

Additional Documents and Resources

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 Drug Formulary Dual Care Plus (HMO SNP) English | español

2021 Find a Pharmacy

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)

2021 CMS Appointment of Representative Form (DSNP)

Additional Documents and Resources