Documents & Forms Center

2021 Principal Choice 15.50.100 Schedule of Copayments

PDF icon 2021-Principal-Choice-15.50.100-Schedule-of-Copayments.pdf

2021 Quality Choice 15.30.50 Schedule of Copayments

PDF icon 2021-Quality-Choice-15.30.50-Schedule-of-Copayments.pdf

2021 Quality Choice 15.50.100 Schedule of Copayments

PDF icon 2021-Quality-Choice-15.50.100-Schedule-of-Copayments.pdf

Medicare 2021

2021 Retiree Advantage Annual Notice of Change Large Print

PDF icon 2021 ANOC Retiree Advantage - Large Print.pdf

Medicare 2021

2021 Retiree Advantage Annual Notice of Changes

PDF icon 2021 Retiree Advantage ANOC.pdf

Medicare 2021

2021 Retiree Advantage Enrollment Application

PDF icon 2021 Retiree Advantage Enrollment Application.pdf

Medicare 2021

2021 Retiree Advantage Evidence of Coverage

PDF icon 2021 Retiree Advantage EOC.pdf

Medicare 2021

2021 Retiree Advantage Evidence of Coverage Large Print

PDF icon 2021 Retiree Advantage Evidence of Coverage_Large Print.pdf

Medicare 2021

2021 Retiree Advantage Formulary

PDF icon 2021 Retiree Advantage Formulary 09152021.pdf

Medicare 2021

2021 Retiree Advantage Summary of Benefits

PDF icon 2021 Retiree Advantage Summary of Benefits.pdf

Medicare 2021

2021 Retiree Advantage Summary of Benefits Large Print

PDF icon 2021 Retiree Advantage Summary of Benefits_Large Print.pdf

2021 SAPPA Summary of Benefits Large Print

2021 SAPPA Summary of Benefits Large Print

2021 Silver Advantage Copay Sheet

PDF icon 2021-Silver-Advantage-Copay-Sheet.pdf

Medicare 2021

2021 Silver Advantage Evidence of Coverage

PDF icon 2021 Silver Advantage EOC.pdf

Medicare 2021

2021 Silver Advantage Evidence of Coverage Large Print

PDF icon 2021 Silver Advantage Evidence of Coverage Large Print.pdf

Medicare 2021

2021 Silver Advantage Formulary

PDF icon 2021 Silver Advantage Formulary 09152021.pdf

Medicare 2021

2021 Silver Advantage, Advantage Plus and Preferred Advantage Summary of Benefits

PDF icon 2021 SAPPA Summary of Benefits.pdf

Medicare 2021

2021 Silver Advantage, Advantage Plus, and Preferred Advantage Enrollment Application

PDF icon 2021 SAPPA Enrollment Application.pdf

Medicare 2021

2021 Silver Advantage, Advantage Plus, and Preferred Advantage Summary of Benefits Large Print

PDF icon 2021-large-print-SOB-SAPPA.pdf

Agents, Employers

2021 Small Group Plan Comparison

PDF icon 2021 Small Group Plan Comparison.pdf

Agents, Employers

2021 Standard Option I 103050 SBC

PDF icon Standard Option I 10.30.50 01-01-21.pdf

2021 State Of Florida Benefit Summary

PDF icon H5938_RA530_M2020 2021 SOF Benefits Summary FINAL.PDF

2021 State of Florida Plan Comparison

PDF icon SOF RA Side By Side Comparison.pdf