Area I
- Franklin
- Johnson
- Logan
- Scott
- Health Advantage HMO enrollment form - English
- Health Advantage HMO enrollment form - Spanish
- Health Advantage Blue Classic (HMO) - Formulary [pdf]
- Health Advantage Blue Classic (HMO) - Formulary - Español [pdf]
- Health Advantage Blue Classic (HMO) - Pharmacy Directory [pdf]
- Health Advantage Blue Classic (HMO) - Pharmacy Directory - Español [pdf]
- Health Advantage Blue Classic (HMO) - Find Pharmacies
- Annual Notice of Change - English
- Annual Notice of Change - Spanish
- Appeals & grievances
- ACH form (H9699)
- Health Advantage SSA form
- Low income subsidy table (H9699)
- 2021 Medicare Star Ratings (H9699)
- 2021 Medicare Star Ratings (H9699) - Spanish
- 2021 Evidence of Coverage
- Rights and Responsibilities Upon Disenrollment
- Summary of Benefits - English
- Summary of Benefits - Spanish
- Medicare Formulary Transition
- 2021 Health Advantage Medicare Advantage Prior Authorization Request Form
- Blue Medicare HMO & PPO enrollment form - English [pdf]
- Blue Medicare HMO & PPO enrollment form - Spanish [pdf]
- BlueMedicare Premier (HMO) - Formulary 002 [pdf]
- BlueMedicare HMO - Pharmacy Directory [pdf]
- BlueMedicare Premier (HMO) - Find Pharmacies
- Appeals & grievances
- ACH form (H6158)
- BlueMedicare SSA form
- Low income subsidy table (H6158)
- 2021 Medicare Star Ratings (H6158)
- 2021 Medicare Star Ratings (H6158) - Spanish
- 2021 Evidence of Coverage
- Rights and Responsibilities Upon Disenrollment
- Summary of Benefits
- Medicare Formulary Transition
- 2021 Arkansas Blue Cross Medicare Advantage Prior Authorization Request Form
- Blue Medicare PFFS enrollment form [pdf]
- Annual Notice of Change
- Appeals & grievances
- ACH form (H4213)
- BlueMedicare SSA form
- Low income subsidy table (H4213)
- 2021 Medicare Star Ratings (H4213)
- 2021 Medicare Star Ratings (H4213) - Spanish
- 2021 Evidence of Coverage
- Rights and Responsibilities Upon Disenrollment
- Summary of Benefits
- 2021 Arkansas Blue Cross Medicare Advantage Prior Authorization Request Form
- Blue Medicare PFFS enrollment form [pdf]
- BlueMedicare Preferred (PFFS) - Formulary [pdf]
- BlueMedicare Preferred (PFFS) - Pharmacy Directory [pdf]
- BlueMedicare Preferred (PFFS) - Find Pharmacies
- Annual Notice of Change
- Appeals & grievances
- ACH form (H4213)
- BlueMedicare SSA form
- Low income subsidy table (H4213)
- 2021 Medicare Star Ratings (H4213)
- 2021 Medicare Star Ratings (H4213) - Spanish
- 2021 Evidence of Coverage
- Rights and Responsibilities Upon Disenrollment
- Summary of Benefits
- Medicare Formulary Transition
- 2021 Arkansas Blue Cross Medicare Advantage Prior Authorization Request Form
- Blue Medicare HMO & PPO enrollment form - English [pdf]
- Blue Medicare HMO & PPO enrollment form - Spanish [pdf]
- BlueMedicare Value Choice (PPO) - Formulary 004-006 [pdf]
- BlueMedicare PPO - Pharmacy Directory [pdf]
- BlueMedicare Value Choice (PPO) - Find Pharmacies
- Appeals & grievances
- ACH form (H3554)
- BlueMedicare SSA form
- Low income subsidy table (H3554)
- 2021 Medicare Star Ratings (H3554)
- 2021 Medicare Star Ratings (H3554) - Spanish
- 2021 Evidence of Coverage
- Rights and Responsibilities Upon Disenrollment
- Summary of Benefits
- Medicare Formulary Transition
- 2021 Arkansas Blue Cross Medicare Advantage Prior Authorization Request Form
- Blue Medicare HMO & PPO enrollment form - English [pdf]
- Blue Medicare HMO & PPO enrollment form - Spanish [pdf]
- BlueMedicare Premier Choice (PPO) - Formulary 008-010 [pdf]
- BlueMedicare PPO - Pharmacy Directory [pdf]
- BlueMedicare Premier Choice (PPO) - Find Pharmacies
- Appeals & grievances
- ACH form (H3554)
- BlueMedicare SSA form
- Low income subsidy table (H3554)
- 2021 Medicare Star Ratings (H3554)
- 2021 Medicare Star Ratings (H3554) - Spanish
- 2021 Evidence of Coverage
- Rights and Responsibilities Upon Disenrollment
- Summary of Benefits
- Medicare Formulary Transition
- 2021 Arkansas Blue Cross Medicare Advantage Prior Authorization Request Form
Y0083_MA Website
Last updated 10/01/2020