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)

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)

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)

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)

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)

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 Annual Notice of Change – Premera Blue Cross Medicare Advantage Core (HMO) - Spanish
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Core (HMO) - Spanish

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 Annual Notice of Change – Premera Blue Cross Medicare Advantage Core Plus (HMO) - Spanish
• 2021 Evidence of Coverage – Premera Blue Cross Medicare Advantage Core Plus (HMO) - Spanish

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)

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)

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)

• All plans
• All plans - Spanish
• Pre enrollment checklist
• Pre enrollment checklist - Spanish

Medicare Advantage (HMO)

• 2020 Annual Notice of Change – Premera Blue Cross Medicare Advantage (HMO)
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage (HMO)

Medicare Advantage Alpine (HMO)

• 2020 Annual Notice of Change – Premera Blue Cross Medicare Advantage Alpine (HMO)
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Alpine (HMO)

Medicare Advantage Charter + Rx (HMO)

• 2020 Annual Notice of Change – Premera Blue Cross Medicare Advantage Charter + Rx (HMO)
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Charter + Rx (HMO)

Medicare Advantage Classic (HMO)

• 2020 Annual Notice of Change – Premera Blue Cross Medicare Advantage Classic (HMO)
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Classic (HMO)

Medicare Advantage Classic Plus (HMO)

• 2020 Annual Notice of Change – Premera Blue Cross Medicare Advantage Classic Plus (HMO)
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Classic Plus (HMO)

Medicare Advantage Core (HMO)

• 2020 Annual Notice of Change – Premera Blue Cross Medicare Advantage Core (HMO)
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Core (HMO)
• 2020 Annual Notice of Change – Premera Blue Cross Medicare Advantage Core (HMO) - Spanish
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Core (HMO) - Spanish

Medicare Advantage Core Plus (HMO)

• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Core Plus (HMO)
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Core Plus (HMO) - Spanish

Medicare Advantage Peak + Rx (HMO)

• 2020 Annual Notice of Change – Premera Blue Cross Medicare Advantage Peak + Rx (HMO)
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Peak + Rx (HMO)

Medicare Advantage Sound + Rx (HMO)

• 2020 Annual Notice of Change – Premera Blue Cross Medicare Advantage Sound + Rx (HMO)
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Sound + Rx (HMO)

Medicare Advantage Total Health (HMO)

• 2020 Annual Notice of Change – Premera Blue Cross Medicare Advantage Total Health (HMO)
• 2020 Evidence of Coverage – Premera Blue Cross Medicare Advantage Total Health (HMO)

• All plans - Island, King, Pierce, San Juan, Skagit, Snohomish, Spokane, Stevens, Thurston, Walla Walla and Whatcom counties
• All plans - Spanish - Island, San Juan, Skagit and Walla Walla
• Pre enrollment checklist (English)
• Pre enrollment checklist (Spanish)

2021

• Diabetic glucose monitors and supplies – (HMO), Core (HMO), Core Plus (HMO), Classic (HMO), Classic Plus (HMO), Total Health (HMO)
• Diabetic glucose monitors and supplies – (HMO), Core (HMO), Core Plus (HMO), Classic (HMO), Classic Plus (HMO), Total Health (HMO) - Spanish
• Diabetic glucose monitors and supplies – Alpine (HMO), Charter + Rx (HMO), Peak + Rx (HMO), Sound + Rx (HMO)
• Diabetic glucose monitors and supplies – Alpine (HMO), Charter + Rx (HMO), Peak + Rx (HMO), Sound + Rx (HMO) - Spanish

2020

• Diabetic glucose monitors and supplies – (HMO), Core (HMO), Core Plus (HMO), Classic (HMO), Classic Plus (HMO), Total Health (HMO)
• Diabetic glucose monitors and supplies – (HMO), Core (HMO), Core Plus (HMO), Classic (HMO), Classic Plus (HMO), Total Health (HMO) - Spanish
• Diabetic glucose monitors and supplies – Alpine (HMO), Charter + Rx (HMO), Peak + Rx (HMO), Sound + Rx (HMO)
• Diabetic glucose monitors and supplies – Alpine (HMO), Charter + Rx (HMO), Peak + Rx (HMO), Sound + Rx (HMO) - Spanish

2021

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

2020

• 2020 Star ratings – Total Health (HMO), Core Plus (HMO), Core (HMO), Classic (HMO), Classic Plus (HMO), Medicare Advantage (HMO)
• 2020 Star ratings – Total Health (HMO), Core Plus (HMO), Core (HMO), Classic (HMO), Classic Plus (HMO), Medicare Advantage (HMO) - Spanish
• 2020 Star ratings – Sound + Rx (HMO), Peak + Rx (HMO), Charter + Rx (HMO), Alpine (HMO)
• 2020 Star ratings – Sound + Rx (HMO), Peak + Rx (HMO), Charter + Rx (HMO), Alpine (HMO) - Spanish