Medicare Advantage Dual Care Plan Documents
Find the documents you need to help you manage your prescription drug plan offered by Blue Cross and Blue Shield of New Mexico.
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Blue Cross Medicare Advantage Dual Care (HMO SNP)SM
2020 Annual Notice of Change Dual Care (HMO SNP) English | español
2020 Evidence of Coverage Dual Care (HMO SNP) English | español
2020 Summary of Benefits Dual Care (DSNP) English | español
2020 Enrollment Form Dual Care (HMO SNP) English | español
2020 Plan Star Rating (HMO SNP) English | español
2020 Drug Formulary (HMO SNP) English | español
2020 Find a Pharmacy English | español
2020 Find a Doctor or Hospital English | español
2020 Low Income Premium Subsidy (HMO SNP) English | español
2020 Prescription Drug Transition Policy (HMO SNP) English | español
2020 Personal Medication List (HMO SNP)
2020 Prescription Drug Coverage Determination Request Form (HMO SNP)
2020 Online Coverage Determination Request Form
2020 Prescription Drug Coverage Redetermination Request Form (HMO SNP)
2020 Online Coverage Redetermination Request Form
2020 Automated Premium Payment (ACH) Form (DSNP)
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Blue Cross Medicare Advantage Dual Care Plus (HMO SNP)SM
2020 Evidence of Coverage Dual Care Plus (HMO SNP) English | español
2020 Summary of Benefits Dual Care Plus (DSNP) English | español
2020 Enrollment Form Dual Care Plus (HMO SNP) English | español
2020 Drug Formulary (HMO SNP) English | español
2020 Plan Star Rating (HMO SNP) English | español
2020 Find a Pharmacy English | español
2020 Find a Doctor or Hospital English | español
2020 Low Income Premium Subsidy (HMO SNP) English | español
2020 Prescription Drug Transition Policy (HMO SNP) English | español
2020 Personal Medication List (HMO SNP)
2020 Prescription Drug Coverage Determination Request Form (HMO SNP)
2020 Online Coverage Determination Request Form
2020 Prescription Drug Coverage Redetermination Request Form (HMO SNP)
2020 Online Coverage Determination Request Form
2020 Automated Premium Payment (ACH) Form (DSNP)
Last Updated: 09302019
Y0096_WEBNMMM20
Last Updated: 09302019
Y0096_WEB_NM_MM20