Medicare Advantage Plan Documents
Find the documents you need to manage your Medicare Advantage Prescription Drug plan offered by Blue Cross and Blue Shield of New Mexico.
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Blue Cross Medicare Advantage Basic (HMO)SM
2019 Annual Notice of Change Basic (HMO) English | español
2019 Evidence of Coverage Basic (HMO) English | español
2019 Summary of Benefits Basic (HMO) English | español
2019 Enrollment Form (HMO English | español
2019 Plan Star Rating Basic (HMO) English | español
2019 Drug Formulary Basic (HMO) English | español
2019 Pharmacy Directory (HMO/PPO) English | español
2019 Provider Directory (HMO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (MAPD) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Personal Medication List (MAPD)
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Select (HMO)SM
2019 Annual Notice of Change Select (HMO) English | español
2019 Evidence of Coverage Select (HMO) English | español
2019 Summary of Benefits Select (HMO) English | español
2019 Enrollment Form Select (HMO) English | español
2019 Plan Star Rating (HMO) English | español
2019 Drug Formulary Select (HMO) English | español
2019 Pharmacy Directory Select (HMO) English | español
2019 Provider Directory Select (HMO/PPO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (MAPD) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Personal Medication List (MAPD)
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
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Blue Cross Medicare Advantage Choice Plus (PPO)SM
2019 Annual Notice of Change Choice Plus (PPO) English | español
2019 Evidence of Coverage Choice Plus (PPO) English | español
2019 Summary of Benefits (PPO) English | español
2019 Enrollment Form (PPO) English | español
2019 Plan Star Rating (PPO) English | español
2019 Drug Formulary Choice Plus (PPO) English | español
2019 Pharmacy Directory (HMO/HMO-POS/PPO) English | español
2019 Provider Directory (PPO) English | español
2019 Dental, Hearing and Vision Provider Directories English | español
2019 Directory Online Request Form English | español
2019 Low Income Premium Subsidy (MAPD) English | español
2019 Prescription Drug Transition Policy (MAPD) English | español
2019 Personal Medication List (MAPD)
2019 Prescription Drug Coverage Determination Request Form (MAPD)
2019 Online Coverage Determination Request Form
2019 Prescription Drug Coverage Redetermination Request Form (MAPD)
2019 Online Coverage Redetermination Request Form
Last Updated: 09302018
Y0096_WEB_NM_MM19 Accepted
Last Updated: 09302018
Y0096_WEB_NM_MM19 Accepted