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
2020 Annual Notice of Change Basic (HMO) English | español
2020 Evidence of Coverage Basic (HMO) English | español
2020 Summary of Benefits Basic (HMO) English | español
2020 Enrollment Form (HMO English | español
2020 Plan Star Rating Basic (HMO) English | español
2020 Drug Formulary Basic (HMO) English | español
2020 Find a Pharmacy English | español
2020 Find a Doctor or Hospital English | español
2020 Low Income Premium Subsidy (MAPD) English | español
2020 Prescription Drug Transition Policy (MAPD) English | español
2020 Personal Medication List (MAPD)
2020 Prescription Drug Coverage Determination Request Form (MAPD)
2020 Online Coverage Determination Request Form
2020 Prescription Drug Coverage Redetermination Request Form (MAPD)
2020 Online Coverage Redetermination Request Form
2020 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Select (HMO)SM
2020 Annual Notice of Change Select (HMO) English | español
2020 Evidence of Coverage Select (HMO) English | español
2020 Summary of Benefits Select (HMO) English | español
2020 Enrollment Form (HMO English | español
2020 Plan Star Rating Basic (HMO) English | español
2020 Drug Formulary Select (HMO) English | español
2020 Find a Pharmacy English | español
2020 Find a Doctor or Hospital English | español
2020 Low Income Premium Subsidy (MAPD) English | español
2020 Prescription Drug Transition Policy (MAPD) English | español
2020 Personal Medication List (MAPD)
2020 Prescription Drug Coverage Determination Request Form (MAPD)
2020 Online Coverage Determination Request Form
2020 Prescription Drug Coverage Redetermination Request Form (MAPD)
2020 Online Coverage Redetermination Request Form
2020 Automated Premium Payment (ACH) Form (MAPD)
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Blue Cross Medicare Advantage Choice Plus (PPO)SM
2020 Annual Notice of Change Choice Plus (PPO) English | español
2020 Evidence of Coverage Choice Plus (PPO) English | español
2020 Summary of Benefits Choice Plus (PPO) English | español
2020 Enrollment Form (PPO) English | español
2020 Plan Star Rating (PPO) English | español
2020 Drug Formulary Choice Plus (PPO) English | español
2020 Find a Pharmacy English | español
2020 Find a Doctor or Hospital English | español
2020 Low Income Premium Subsidy (MAPD) English | español
2020 Prescription Drug Transition Policy (MAPD) English | español
2020 Personal Medication List (MAPD)
2020 Prescription Drug Coverage Determination Request Form (MAPD)
2020 Online Coverage Determination Request Form
2020 Prescription Drug Coverage Redetermination Request Form (MAPD)
2020 Online Coverage Redetermination Request Form
2020 Automated Premium Payment (ACH) Form (MAPD)
Last Updated: 09302019
Y0096_WEBNMMM20
Last Updated: 09302019
Y0096_WEB_NM_MM20