Looking for a prescription drug plan document or a certain form? Use thie links below to browse by plan type. Note that these links are on a third-party website.
Browse Forms by Plan Type: 2018
Browse Forms by Plan Type: 2019
If you would like a friend, relative, your doctor or other provider, or other person to be your representative to ask for a coverage decision or make an appeal, please call Member Services.
Florida Blue/Florida Blue HMO members call 1-800-926-6565, TTY number 1-800-955-8770. We are open from 8 a.m. - 8 p.m. local time, seven days a week from October 1 - February 14, and closed Federal Holidays except for Thanksgiving and Christmas. From February 15 - September 30, we are open Monday - Friday 8 a.m. - 8 p.m. local time, except for Federal holidays.
Florida Blue Preferred HMO members, please call 1-844-783-5189, TTY number 1-800-955-8770. We are open from 8 a.m. - 8 p.m. local time, seven days a week.
Ask for the “Appointment of Representative” form. (The form is also available on Medicare’s website via the link below). The form gives that person permission to act on your behalf. It must be signed by you and by the person who you would like to act on your behalf. You must send us a copy of the signed form. Instructions on where to send the form are included in the form.