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Find the documents you need to manage your Medicare Advantage Prescription Drug plan offered by Blue Cross and Blue Shield of New Mexico.
2021 Annual Notice of Change Basic (HMO) English | español
2021 Evidence of Coverage Basic (HMO) English | español
2021 Summary of Benefits Basic (HMO) English | español
2021 Plan Star Rating (HMO) English | español
2021 Enrollment Form (HMO English | español
2021 Drug Formulary Basic (HMO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (MAPD) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Personal Medication List (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
2021 Annual Notice of Change Select (HMO) English | español
2021 Evidence of Coverage Select (HMO) English | español
2021 Summary of Benefits Select (HMO) English | español
2021 Plan Star Rating (HMO) English | español
2021 Enrollment Form (HMO English | español
2021 Drug Formulary Select (HMO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (MAPD) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Personal Medication List (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (HMO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (HMO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
2021 Annual Notice of Change Choice Plus (PPO) English | español
2021 Evidence of Coverage Choice Plus (PPO) English | español
2021 Summary of Benefits Choice Plus (PPO) English | español
2021 Plan Star Rating (PPO) English | español
2021 Enrollment Form (PPO) English | español
2021 Drug Formulary Choice Plus (PPO) English | español
2021 Pharmacy Directory English | español
2021 Find a Doctor or Hospital English | español
2021 Low Income Premium Subsidy (MAPD) English | español
2021 Prescription Drug Transition Policy (MAPD) English | español
2021 Personal Medication List (MAPD) English | español
2021 Prescription Drug Coverage Determination Request Form (PPO) English | español
2021 Online Coverage Determination Request Form
2021 Prescription Drug Coverage Redetermination Request Form (PPO) English | español
2021 Online Coverage Redetermination Request Form
2021 Automated Premium Payment (ACH) Form (MAPD)
Last Updated: 12312020
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Last Updated: 03182021
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