Find Medicare Forms
Looking for a plan document or a certain form? All CMS required documents are included below.
Results
| Year | Links | ||||
|---|---|---|---|---|---|
| 2020 Total/Secure Comprehensive Formulary (PDF) | BlueCross Total PPO,BlueCross Secure HMO | Comprehensive Formulary (PDF) | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2020 BlueCross RxValue Comprehensive Formulary (PDF) | BlueCross Value Rx , BlueCross Value Rx | Comprehensive Formulary (PDF) | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2020 BlueCross RxPlus Comprehensive Formulary (PDF) | BlueCross Plus Rx | Comprehensive Formulary (PDF) | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| Secure-Total 2021 Formulary | do-not-filter | Comprehensive Formulary (PDF) | do-not-filter | 2021 | |
| Total Value 2021 Formulary | do-not-filter | Comprehensive Formulary (PDF) | do-not-filter | 2021 | |
| Rx Value 2021 Formulary | do-not-filter | Comprehensive Formulary (PDF) | do-not-filter | 2021 | |
| 2021 Rx Plus 2021 Formulary | do-not-filter | Comprehensive Formulary (PDF) | do-not-filter | 2021 | |
| 2020 BlueCross Total Upstate PPO Evidence of Coverage (PDF) | BlueCross Total PPO | Evidence of Coverage (PDF) | do-not-filter | 2020 | |
| 2020 BlueCrossTotal Midlands Coastal PPO Evidence of Coverage (PDF) | BlueCross Total PPO | Evidence of Coverage (PDF) | do-not-filter | 2020 | |
| 2020 BlueCross Total Lowcountry PPO Evidence of Coverage (PDF) | BlueCross Total PPO | Evidence of Coverage (PDF) | do-not-filter | 2020 | |
| 2020 BlueCross Secure Greenville HMO Evidence of Coverage (PDF) | BlueCross Secure HMO | Evidence of Coverage (PDF) | do-not-filter | 2020 | |
| 2020 BlueCross Secure Richland HMO Evidence of Coverage (PDF) | BlueCross Secure HMO | Evidence of Coverage (PDF) | do-not-filter | 2020 | |
| 2020 BlueCross Rx Value EOC (PDF) | BlueCross Value Rx | Evidence of Coverage (PDF) | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2020 BlueCross Rx Plus EOC (PDF) | BlueCross Plus Rx | Evidence of Coverage (PDF) | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2021 BlueCross Secure Richland EOC | do-not-filter | Evidence of Coverage (PDF) | do-not-filter | 2021 | |
| 2021 BlueCross Secure Greenville EOC | do-not-filter | Evidence of Coverage (PDF) | do-not-filter | 2021 | |
| 2021 BlueCross Rx Value (PDP) EOC | do-not-filter | Evidence of Coverage (PDF) | do-not-filter | 2021 | |
| 2021 BlueCross Rx Plus (PDP) EOC | do-not-filter | Evidence of Coverage (PDF) | do-not-filter | 2021 | |
| 2021 Total Lowcountry EOC | do-not-filter | Evidence of Coverage (PDF) | do-not-filter | 2021 | |
| 2021 Total Upstate EOC | do-not-filter | Evidence of Coverage (PDF) | do-not-filter | 2021 | |
| 2021 Total Midlands-Coastal EOC | do-not-filter | Evidence of Coverage (PDF) | do-not-filter | 2021 | |
| 2021 Total Value Midlands-Coastal EOC | do-not-filter | Evidence of Coverage (PDF) | do-not-filter | 2021 | |
| 2021 Total Value Upstate EOC | do-not-filter | Evidence of Coverage (PDF) | do-not-filter | 2021 | |
| 2020 MA Transition Policy (PDF) | BlueCross Total PPO,BlueCross Secure HMO,BlueCross Value Rx,BlueCross Plus Rx | Transition Policy | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2021 Rx Prescription Drug Transition Policy (PDF) | BlueCross Value Rx,BlueCross Plus Rx,BlueCross Total PPO,BlueCross Secure HMO | Transition Policy | do-not-filter | 2021 | |
| 2021 MA Transition Policy (PDF) | BlueCross Value Rx,BlueCross Plus Rx,BlueCross Total PPO,BlueCross Secure HMO | Transition Policy | do-not-filter | 2021 | |
| 2020 Rx Value/Rx Plus LIS Summary | BlueCross Total PPO,BlueCross Secure HMO,BlueCross Value Rx,BlueCross Plus Rx | Low Income Subsidy Premium Summary Table for Those Receiving Extra Help (PDF) | do-not-filter | 2020 | |
| BlueCross Total LIS Summary | BlueCross Total PPO | Low Income Subsidy Premium Summary Table for Those Receiving Extra Help (PDF) | do-not-filter | 2020 | |
| BlueCross Secure LIS Summary | BlueCross Secure HMO | Low Income Subsidy Premium Summary Table for Those Receiving Extra Help (PDF) | do-not-filter | 2020 | |
| BlueCross Total LIS Summary | BlueCross Total PPO | Low Income Subsidy Premium Summary Table for Those Receiving Extra Help (PDF) | do-not-filter | 2021 | |
| BlueCross Total Value LIS Summary | BlueCross Total Value PPO | Low Income Subsidy Premium Summary Table for Those Receiving Extra Help (PDF) | do-not-filter | 2021 | |
| BlueCross Secure LIS Summary | BlueCross Secure HMO | Low Income Subsidy Premium Summary Table for Those Receiving Extra Help (PDF) | do-not-filter | 2021 | |
| 2021 Rx Value/Rx Plus LIS Summary | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , BlueCross Value Rx | Low Income Subsidy Premium Summary Table for Those Receiving Extra Help (PDF) | do-not-filter | 2021 | |
| 2020 BlueCross Secure Summary of Benefits (PDF) | BlueCross Secure HMO | Summary of Benefits (PDF) | do-not-filter | 2020 | |
| 2020 BlueCross Total Summary of Benefits (PDF) | BlueCross Total PPO | Summary of Benefits (PDF) | do-not-filter | 2020 | |
| 2020 Rx Value and Rx Plus Summary of Benefits(PDF) | BlueCross Value Rx,BlueCross Plus Rx | Summary of Benefits (PDF) | do-not-filter | 2020 | |
| 2021 Rx Value and Rx Plus Summary of Benefits(PDF) | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , Rx | Summary of Benefits (PDF) | do-not-filter | 2021 | |
| 2021 BlueCross Total Summary of Benefits (PDF) | BlueCross Total PPO | Summary of Benefits (PDF) | do-not-filter | 2021 | |
| 2021 BlueCross Total Value Summary of Benefits (PDF) | BlueCross Total Value PPO | Summary of Benefits (PDF) | do-not-filter | 2021 | |
| 2021 BlueCross Secure Summary of Benefits (PDF) | BlueCross Secure HMO | Summary of Benefits (PDF) | do-not-filter | 2021 | |
| 2020 BlueCare Outline Plans A B D G | Bluecare Plan, Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2020 | |
| 2020 BlueCare Outline Plans A C F HiF | Bluecare Plan, Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2020 | |
| 2020 BlueCare Outline Plans A HiG L N | Bluecare Plan, Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2020 | |
| 2020 BlueCare Outline Plans A K | Bluecare Plan, Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2020 | |
| 2020 Blue Select Outline Plans A B D G | Blue Select, Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2020 | |
| 2020 Blue Select Outline Plans A C F HiF | Blue Select, Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2020 | |
| 2020 Blue Select Outline Plans A HiG L N | Blue Select, Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2020 | |
| 2020 Blue Select Outline Plans A K | Blue Select, Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2020 | |
| BlueCare Outline of Coverage Plans A, B, D, G | Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2021 | |
| BlueCare Outline of Coverage Plans A, C, F, F with HD | Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2021 | |
| BlueCare Outline of Coverage Plans A, G with HD, L, N | Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2021 | |
| Blue Select Outline of Coverage Plans A, K | Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2021 | |
| Blue Select Outline of Coverage Plans A B, D, G | Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2021 | |
| Blue Select Outline of Coverage Plans A C, F, F with HD | Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2021 | |
| Blue Select Outline of Coverage Plans A G with HD, L, N | Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2021 | |
| BlueCare Outline of Coverage Plans A, K | Supplement | Outline of Coverage "OOC" (pdf) | do-not-filter | 2021 | |
| 2020 Rx Coverage Determination Form (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Coverage Determination | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2021 Rx Coverage Determination Form (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Coverage Determination | do-not-filter | 2021 | |
| 2020 Rx Coverage Redetermination Form (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Coverage Redetermination | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2021 Rx Coverage Redetermination Form (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Coverage Redetermination | do-not-filter | 2021 | |
| BlueCross Rx Value and Rx Plus Plan Rating (PDF) | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , BlueCross Value Rx | Star Rating | do-not-filter | 2021 | |
| Appointment of Representative Form (PDF) | BlueCross Total PPO,BlueCross Secure HMO,BlueCross Value Rx,BlueCross Plus Rx | Appointment of representative form | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| Appointment of Representative Form (PDF) | BlueCross Value Rx,BlueCross Plus Rx,BlueCross Total PPO,BlueCross Secure HMO | Appointment of representative form | do-not-filter | 2021 | |
| 2020 BlueCross BlueShield Medicare Advantage/Rx PHI Disclosure Form (PDF) | BlueCross Total PPO,BlueCross Secure HMO,BlueCross Value Rx,BlueCross Plus Rx | PHI Disclosure Form | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2021 BlueCross BlueShield Medicare Advantage/Rx PHI Disclosure Form (PDF) | BlueCross Value Rx,BlueCross Plus Rx,BlueCross Total PPO,BlueCross Secure HMO | PHI Disclosure Form | do-not-filter | 2021 | |
| 2020 Prescription drug claim form (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Prescription drug claim form | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| Prescription drug claim form (PDF) | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , BlueCross Value Rx | Prescription drug claim form | do-not-filter | 2021 | |
| Prescription Drug Grievance Information | BlueCross Value Rx,BlueCross Plus Rx | Miscellaneous | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| Medicare Advantage Grievance Information | BlueCross Total PPO,BlueCross Secure HMO | Miscellaneous | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2020 BlueCross Secure Richland HMO Provider Directory (URL) | BlueCross Secure HMO | Miscellaneous | do-not-filter | 2020 | |
| 2020 BlueCross Secure Greenville HMO Provider Directory (URL) | BlueCross Secure HMO | Miscellaneous | do-not-filter | 2020 | |
| 2020 Rx Value/Rx Plus Coverage Determinations and Redeterminations (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Miscellaneous | do-not-filter | 2020 | |
| OON Drug Coverage Rules | BlueCross Total PPO,BlueCross Secure HMO,BlueCross Value Rx,BlueCross Plus Rx | Miscellaneous | do-not-filter | 2020 | |
| MA Coverage Decision and Appeal Information | BlueCross Total PPO,BlueCross Secure HMO | Miscellaneous | do-not-filter | 2020 | |
| Prescription Drug Grievance Information | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , BlueCross Value Rx | Miscellaneous | do-not-filter | 2021 | |
| 2020 BlueCross Rx Value and Rx Plus Enrollment Application (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Enrollment Form | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2020 BlueCross Total PPO MAPD Enrollment Application (PDF) | BlueCross Total PPO | Enrollment Form | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2020 BlueCross Secure HMO MAPD Enrollment Application (PDF) | BlueCross Secure HMO | Enrollment Form | do-not-filter | 2020 | |
| 2021 BlueCross Total PPO Enrollment Application (PDF) | BlueCross Total PPO | Enrollment Form | do-not-filter | 2021 | |
| 2021 BlueCross Total Value PPO Enrollment Application (PDF) | BlueCross Total PPO | Enrollment Form | do-not-filter | 2021 | |
| 2021 BlueCross Secure HMO MAPD Enrollment Application (PDF) | BlueCross Secure HMO | Enrollment Form | do-not-filter | 2021 | |
| 2021 BlueCross Rx Value and Rx Plus Enrollment Application (PDF) | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , BlueCross Value Rx, BlueCross Value Rx,BlueCross Plus Rx | Enrollment Form | do-not-filter | 2021 | |
| 2020 BlueCross Secure HMO Enrollment Instructions (PDF) | BlueCross Secure HMO | Enrollment Form Instructions | do-not-filter | 2020 | |
| 2020 BlueCross Total PPO Enrollment Instructions (PDF) | BlueCross Total PPO | Enrollment Form Instructions | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2020 BlueCross Rx Value and Rx Plus Enrollment Instructions (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Enrollment Form Instructions | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2020 Rx Prescription Drug Transition Policy (PDF) | BlueCross Total PPO,BlueCross Secure HMO,BlueCross Value Rx,BlueCross Plus Rx | General Transition Notice | do-not-filter | 2020 | |
| BlueCross Rx Value and Rx Plus Plan Rating (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Plan Rating | do-not-filter | 2020 | |
| BlueCross Total Star Ratings | BlueCross Total PPO | Plan Rating | do-not-filter | 2020 | |
| BlueCross Secure Star Ratings | BlueCross Secure HMO | Plan Rating | do-not-filter | 2020 | |
| 2021 BlueCross Total PPO Star Ratings | BlueCross Total PPO | Plan Rating | do-not-filter | 2021 | |
| 2021 BlueCross Secure HMO Star Ratings | BlueCross Secure HMO | Plan Rating | do-not-filter | 2021 | |
| 2021 PDP Star Ratings | do-not-filter | Plan Rating | do-not-filter | 2021 | |
| 2020 BlueCross Total Provider Directory (URL) | BlueCross Total PPO | Provider Directory | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2020 BlueCross Secure Richland HMO Provider Directory (PDF) | BlueCross Secure HMO | Provider Directory | do-not-filter | 2020 | |
| 2020 BlueCross Secure Greenville HMO Provider Directory (PDF) | BlueCross Secure HMO | Provider Directory | do-not-filter | 2020 | |
| 2020 BlueCross Total Provider Directory (pdf) | do-not-filter | Provider Directory | do-not-filter | 2020 | |
| 2021 BlueCross Total/Total Value Provider Directory (URL) | BlueCross Total PPO, BlueCross Total Value PPO, BlueCross Total Value PPO | Provider Directory | do-not-filter | 2021 | |
| 2021 BlueCross Total/Total Value Provider Directory (pdf) | BlueCross Total PPO | Provider Directory | do-not-filter | 2021 | |
| 2021 BlueCross Secure HMO Provider Directory (pdf) | BlueCross Secure HMO | Provider Directory | do-not-filter | 2021 | |
| 2021 BlueCross Secure HMO Provider Directory (URL) | BlueCross Secure HMO | Provider Directory | do-not-filter | 2021 | |
| 2020 Secure/Total Pharmacy Directory (PDF) | BlueCross Total PPO,BlueCross Secure HMO | Pharmacy Directory | do-not-filter | 2020 | |
| 2020 Rx Value/Rx Plus Pharmacy Directory (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Pharmacy Directory | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2021 Rx Value/Rx Plus Pharmacy Directory (PDF) | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , BlueCross Value Rx, BlueCross Value Rx,BlueCross Plus Rx | Pharmacy Directory | do-not-filter | 2021 | |
| 2021 PDP Pharmacy Directory | do-not-filter | Pharmacy Directory | do-not-filter | 2021 | |
| 2021 MAPD Pharmacy Directory | do-not-filter | Pharmacy Directory | do-not-filter | 2021 | |
| Medicare Advantage (Medical) claim form (PDF) | BlueCross Total PPO,BlueCross Secure HMO | Health claim form | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| Medicare Advantage (Medical) claim form (PDF) | BlueCross Total PPO,BlueCross Secure HMO | Health claim form | do-not-filter | 2021 | |
| Medicare Advantage Grievance Information | BlueCross Total PPO,BlueCross Secure HMO | Grievance Information | do-not-filter | 2021 | |
| 2020 Medicare Extra Help Program | BlueCross Total PPO,BlueCross Secure HMO | Extra Help Program | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2020 Rx Medicare Extra Help Program | BlueCross Value Rx,BlueCross Plus Rx | Extra Help Program | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2021 Rx Medicare Extra Help Program | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , BlueCross Value Rx, BlueCross Value Rx,BlueCross Plus Rx | Extra Help Program | do-not-filter | 2021 | |
| 2021 Medicare Extra Help Program | BlueCross Total PPO,BlueCross Secure HMO | Extra Help Program | do-not-filter | 2021 | |
| 2020 Medicare Therapy Management Program | BlueCross Total PPO,BlueCross Secure HMO,BlueCross Value Rx,BlueCross Plus Rx | Medicare Therapy Management Program | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2021 Medicare Therapy Management Program | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , BlueCross Value Rx | Medicare Therapy Management Program | do-not-filter | 2021 | |
| MAPD Out of Network Coverage Rules | BlueCross Total PPO,BlueCross Secure HMO | Out Of Network Coverage Rules | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| OON Drug Coverage Rules | BlueCross Value Rx,BlueCross Plus Rx,BlueCross Total PPO,BlueCross Secure HMO | Out Of Network Coverage Rules | do-not-filter | 2021 | |
| MAPD Out of Network Coverage Rules | BlueCross Total PPO,BlueCross Secure HMO | Out Of Network Coverage Rules | do-not-filter | 2021 | |
| 2020 Prescription Drug Mail Order Form (PDF) | BlueCross Value Rx,BlueCross Plus Rx | Mail Order Form | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2021 Prescription Drug Mail Order Form (PDF) | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , BlueCross Value Rx | Mail Order Form | do-not-filter | 2021 | |
| 2020 Rights and Responsibilities Upon Disenrollment | BlueCross Total PPO,BlueCross Secure HMO,BlueCross Value Rx,BlueCross Plus Rx | Disenrollment | ABBEVILLE, AIKEN, ALLENDALE, ANDERSON, BAMBERG, BARNWELL, BEAUFORT, BERKELEY, CALHOUN, CHARLESTON, CHEROKEE, CHESTER, CHESTERFIELD, CLARENDON, COLLETON, DARLINGTON, DILLON, DORCHESTER, EDGEFIELD, FAIRFIELD, FLORENCE, GEORGETOWN, GREENVILLE, GREENWOOD, HAMPTON, HORRY, JASPER, KERSHAW, LANCASTER, LAURENS, LEE, LEXINGTON, MARION, MARLBORO, MCCORMICK, NEWBERRY, OCONEE, ORANGEBURG, PICKENS, RICHLAND, SALUDA, SPARTANBURG, SUMTER, UNION, WILLIAMSBURG, YORK | 2020 | |
| 2021 MAPD ST Criteria | do-not-filter | Step Therapy Criteria | do-not-filter | 2021 | |
| 2021 PDP ST Criteria | do-not-filter | Step Therapy Criteria | do-not-filter | 2021 | |
| 2020 BlueCross Rx Step Therapy Criteria | do-not-filter | BlueCross Rx Step Therapy Criteria | do-not-filter | 2020 | |
| 2020 BlueCross Rx Prior Authorization Criteria | do-not-filter | BlueCross Rx Prior Authorization Criteria | do-not-filter | 2020 | |
| 2021 PDP PA Criteria | do-not-filter | BlueCross Rx Prior Authorization Criteria | do-not-filter | 2021 | |
| 2020 BlueCross MAPD Prior Authorization Criteria | do-not-filter | BlueCross MAPD Prior Authorization Criteria | do-not-filter | 2020 | |
| 2021 MAPD PA Criteria | do-not-filter | BlueCross MAPD Prior Authorization Criteria | do-not-filter | 2021 | |
| 2020 BlueCross MAPD Step Therapy Criteria | do-not-filter | BlueCross MAPD Step Therapy Criteria | do-not-filter | 2020 | |
| Replacement of Coverage | do-not-filter | Replacement of Coverage | do-not-filter | 2020 | |
| 2021 Rx Value/Rx Plus Coverage Determinations and Redeterminations (PDF) | BlueCross Plus Rx, BlueCross Rx Plus, BlueCross Rx Value, BlueCross Value Rx , BlueCross Value Rx | Determination and Redetermination Policy | do-not-filter | 2021 |