Documents & Forms Center

Agents, Employers

2021 3104 - Gold 2065100

PDF icon 3104 Gold 2065100.pdf

Agents, Employers

2021 3107 - Gold 6 Tier Rx SBC

PDF icon 3107 Gold 6Tier Rx.pdf

Medicare 2021

2021 Advantage Plus Annual Notice of Changes

PDF icon 2021 Advantage Plus ANOC.pdf

Medicare 2021

2021 APPA Formulary

PDF icon 2021 APPA Formulary 09152020.pdf

Agents, Employers

2021 Basic Option I 1050100 SBC

PDF icon Basic Option I 10.50.100.pdf

Agents, Employers

2021 Basic Option II 1050100 SBC

PDF icon Basic Option II 10.50.100.pdf

Agents, Employers

2021 Essential Selection 153050 SBC

PDF icon Essential Selection 15.30.50.pdf

Agents, Employers

2021 Essential Selection No Rx SBC

PDF icon Essential Selection No Rx.pdf

Agents, Employers

2021 Large Group Plan Comparison

PDF icon 2021 Large Group Plan Comparison.pdf

Medicare 2021

2021 Preferred Advantage Annual Notice of Changes

PDF icon 2021 Preferred Advantage ANOC.pdf

Medicare 2021

2021 Preferred Advantage Evidence of Coverage

PDF icon 2021 Preferred Advantage EOC.pdf

Medicare 2021

2021 Retiree Advantage Annual Notice of Changes

PDF icon 2021 Retiree Advantage ANOC.pdf

Medicare 2021

2021 Retiree Advantage Enrollment Application

PDF icon 2021 Retiree Advantage Enrollment Application.pdf

Medicare 2021

2021 Retiree Advantage Evidence of Coverage

PDF icon 2021 Retiree Advantage EOC.pdf

Medicare 2021

2021 Retiree Advantage Formulary

PDF icon 2021 RA Formulary 09152020.pdf

Medicare 2021

2021 Retiree Advantage Summary of Benefits

PDF icon 2021 Retiree Advantage Summary of Benefits.pdf

Medicare 2021

2021 Silver Advantage Evidence of Coverage

PDF icon 2021 Silver Advantage EOC.pdf

Medicare 2021

2021 Silver Advantage Formulary

PDF icon 2021 Silver Advantage Formulary 09152020.pdf

Medicare 2021

2021 Silver Advantage, Advantage Plus and Preferred Advantage Summary of Benefits

PDF icon 2021 SAPPA Summary of Benefits.pdf

Medicare 2021

2021 Silver Advantage, Advantage Plus, and Preferred Advantage Enrollment Application

PDF icon 2021 SAPPA Enrollment Application.pdf

Agents, Employers

2021 Small Group Plan Comparison

PDF icon 2021 Small Group Plan Comparison.pdf

Agents, Employers

2021 Standard Option I 103050 SBC

PDF icon Standard Option I 10.30.50 01-01-21.pdf

2021 State Of Florida Benefit Summary

PDF icon H5938_RA530_M2020 2021 SOF Benefits Summary FINAL.PDF

2021 State of Florida Plan Comparison

PDF icon SOF RA Side By Side Comparison.pdf