Documents & Forms Center

Agents, Employers

2024 Small Group Benefits - Side-by-Side

PDF icon 2024 ACA and ABP Benefits - FINAL.pdf

2024 SOF Comparison

PDF icon 2024_SOF_RA_Comparison.pdf

Medicare 2024

2024 SOF DE Schedule of Copayments

PDF icon 2024-SOF-DE-Schedule-of-Copayments.pdf

2024 SOF Retiree Advantage Evidence of Coverage Large Print

PDF icon LP_2024 SOF Retiree HMO EOC (003).pdf

2024 State of Florida Comparison Sheet

PDF icon 2024-State-of-Florida-Comparison-Sheet.pdf

State of Florida

2024 State of Florida High Deductible SBC

PDF icon 2024-SOF-HighDeductible-SBC.pdf

State of Florida

2024 State of Florida Medicare High Deductible SBC

PDF icon 2024-SOF-Medicare-HighDeductible-SBC.pdf

State of Florida

2024 State of Florida Medicare Standard SBC

PDF icon 2024-SOF-Medicare-Standard-SBC.pdf

State of Florida

2024 State of Florida Member Handbook

PDF icon State of Florida 2024 SPD - Member Handbook.pdf

2024 State of Florida Retiree Advantage Evidence of Coverage

PDF icon H5938-804-HMO-EOC-2024_508.pdf

2024 State of Florida Retiree Advantage Plan Comparison

PDF icon 2024-State-of-Florida-Comparison-Sheet.pdf

2024 State of Florida Retiree Advantage Schedule of Copayments

PDF icon 2024-State-of-Florida-Retiree-Advantage-Schedule-of-Copayments.pdf

2024 State of Florida Retiree Advantage Schedule of Copayments

PDF icon 2024-State-of-Florida-Retiree-Advantage-Schedule-of-Copayments.pdf

2024 State of Florida Retiree Classic Schedule of Copayments

PDF icon 2024-State-of-Florida-Retiree-Classic-Schedule-of-Copayments.pdf

2024 State of Florida Retiree Classic Schedule of Copayments

PDF icon 2024-State-of-Florida-Retiree-Classic-Schedule-of-Copayments.pdf

State of Florida

2024 State of Florida Standard SBC

PDF icon 2024-SOF-Standard-SBC.pdf

2024 TMH Schedule of Copays

PDF icon 2024-TMH-Schedule-of-Copays.pdf

2024 Transition Policy

PDF icon 2024-Transition-Policy.pdf

Members

2025 HMO Individual Contract

PDF icon 2024.21.HMO_.IndQHP-COC.pdf

22-23 Large Group Benefits

PDF icon 2023 Large Group Benefits - External.pdf

Agents, Employers

3101 - Platinum 153050 2020

PDF icon 3101 Platinum 2020.pdf

3101 Platinum 2022

PDF icon 3101 Platinum 2022.pdf

3101 RE Platinum 2022

PDF icon 3101-re-platinum-2022.pdf

Members

3102 - Platinum 2021

PDF icon 3102 Platinum 2021.pdf