Documents & Forms Center

Medicare 2021

2021 State of Florida Retiree Advantage Evidence of Coverage

PDF icon 2021 SOF Retiree Advantage EOC.pdf

Medicare 2021

2021 State of Florida Retiree Advantage Evidence of Coverage Large Print

PDF icon 2021 SOF RA EOC - Large Print.pdf

2021 State of Florida Retiree Advantage Schedule of Copayments

PDF icon 2021-State-of-Florida-Retiree-Advantage-Schedule-of-Copayments.pdf

2021 State of Florida Retiree Classic Schedule of Copayments

PDF icon 2021-State-of-Florida-Retiree-Classic-Schedule-of-Copayments.pdf

2021 State of Florida Retiree Plan Comparisons

PDF icon SOF-Retiree-Plan-Comparisons.pdf

Agents, Employers

2021 Tiered PCP 153050 SBC

PDF icon Tiered PCP Selection 15.30.50.pdf

Agents, Employers

2021 Tiered PCP No Rx SBC

PDF icon Tiered PCP Selection No Rx.pdf

2022 Advantage Plus Annual Notice of Change

PDF icon 2022 ADVANTAGE PLUS ANOC_508.pdf

2022 Advantage Plus ANOC Large Print

PDF icon 2022-ANOC-ADVANTAGE-PLUS_final-LP-FINAL.pdf

2022 Advantage Plus Copay Sheet

PDF icon 2022-advantage-plus-copay-sheet.pdf

2022 Advantage Plus Evidence of Coverage

PDF icon 2022 Advantage Plus EOC_508.pdf

2022 Advantage Plus Evidence of Coverage_Large Print

PDF icon 2022 Advantage Plus EOC - LP.pdf

2022 Big Bend Choice Schedule of Copays

PDF icon 2022-big-bend-choice-of-copays.pdf

2022 Capital City Bank Retiree Advantage

PDF icon 2022-capital-city-bank-retiree-advantage.pdf

2022 Capital Selection 15-30-50 Copay Sheet

PDF icon 2022-capital-selection-15-30-50-copay-sheet.pdf

2022 Dual Eligible Schedule of Copayments

PDF icon 2022-DE-Schedule-of-Copayments.pdf

2022 FEHB Benefit Brochure

PDF icon RI 73-197.pdf

2022 FEHB Summary of Benefits

PDF icon FEHB 2022.pdf

Members

2022 HMO Individual Contract

PDF icon 2021.18.HMO_.IndQHP-COC.pdf

Members

2022 HMO Individual Contract

PDF icon 2021.18.HMO_.IndQHP-COC.pdf

Medicare

2022 Medicare Made Easy Brochure

PDF icon 2022 Medicare Made Easy Brochure.pdf

2022 Preferred Advantage Annual Notice of Change

PDF icon 2022 PREFERRED ADVANTAGE ANOC_508.pdf

2022 Preferred Advantage ANOC Large Print

PDF icon 2022-ANOC-PREFERRED-ADVANTAGE_Final-LP-FINAL.pdf

2022 Preferred Advantage Copay Sheet

PDF icon 2022-preferred-advantage-copay-sheet.pdf