Plan Documents

Medicare Advantage (HMO)

• 2021 Annual Notice of Change – Premera Blue Cross Medicare Advantage (HMO)
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage (HMO)
• Diabetic glucose monitors and supplies preferred brands and manufacturers

Medicare Advantage Alpine (HMO)

• 2021 Annual Notice of Change – Premera Blue Cross Medicare Advantage Alpine (HMO)
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Alpine (HMO)
• Diabetic glucose monitors and supplies preferred brands and manufacturers

Medicare Advantage Charter + Rx (HMO)

• 2021 Annual Notice of Change – Premera Blue Cross Medicare Advantage Charter + Rx (HMO)
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Charter + Rx (HMO)
• Diabetic glucose monitors and supplies preferred brands and manufacturers

Medicare Advantage Classic (HMO)

• 2021 Annual Notice of Change – Premera Blue Cross Medicare Advantage Classic (HMO)
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Classic (HMO)
• Diabetic glucose monitors and supplies preferred brands and manufacturers

Medicare Advantage Classic Plus (HMO)

• 2021 Annual Notice of Change – Premera Blue Cross Medicare Advantage Classic Plus (HMO)
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Classic Plus (HMO)
• Diabetic glucose monitors and supplies preferred brands and manufacturers

Medicare Advantage Core (HMO)

• 2021 Annual Notice of Change – Premera Blue Cross Medicare Advantage Core (HMO)
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Core (HMO)
• 2021 Notificación anual de cambios – Premera Blue Cross Medicare Advantage Core (HMO)
• 2021 Evidencia de cobertura – Premera Blue Cross Medicare Advantage Core (HMO)
• Diabetic glucose monitors and supplies preferred brands and manufacturers
• Suministros y medidores de glucosa para clientes con diabetes

Medicare Advantage Core Plus (HMO)

• 2021 Annual Notice of Change – Premera Blue Cross Medicare Advantage Core Plus (HMO)
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Core Plus (HMO)
• 2021 Notificación anual de cambios – Premera Blue Cross Medicare Advantage Core Plus (HMO)
• 2021 Evidencia de cobertura – Premera Blue Cross Medicare Advantage Core Plus (HMO)
• Diabetic glucose monitors and supplies preferred brands and manufacturers
• Suministros y medidores de glucosa para clientes con diabetes

Medicare Advantage Peak + Rx (HMO)

• 2021 Annual Notice of Change – Premera Blue Cross Medicare Advantage Peak + Rx (HMO)
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Peak + Rx (HMO)
• Diabetic glucose monitors and supplies preferred brands and manufacturers

Medicare Advantage Sound + Rx (HMO)

• 2021 Annual Notice of Change – Premera Blue Cross Medicare Advantage Sound + Rx (HMO)
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Sound + Rx (HMO)
• Diabetic glucose monitors and supplies preferred brands and manufacturers

Medicare Advantage Total Health (HMO)

• 2021 Annual Notice of Change – Premera Blue Cross Medicare Advantage Total Health (HMO)
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Total Health (HMO)
• Diabetic glucose monitors and supplies preferred brands and manufacturers

• All plans
• Resumen de beneficios
• Pre enrollment checklist
• Lista de verificación de preinscripción

2021

• 2021 Star ratings – Total Health (HMO), Core Plus (HMO), Core (HMO), Classic (HMO), Classic Plus (HMO), Medicare Advantage (HMO)
• 2021 Calificaciones por estrellas Medicare – Total Health (HMO), Core Plus (HMO), Core (HMO), Classic (HMO), Classic Plus (HMO), Medicare Advantage (HMO)
• 2021 Star ratings – Sound + Rx (HMO), Peak + Rx (HMO), Charter + Rx (HMO), Alpine (HMO)
• 2021 Calificaciones por estrellas Medicare – Sound + Rx (HMO), Peak + Rx (HMO), Charter + Rx (HMO), Alpine (HMO)