Documents & Forms Center

Medicare

2020 SOF Benefits Summary

PDF icon 2020 Retiree Advantage Summary of Benefits.pdf

Members

2020 SOF High Deductible Health HMO Plan SBC

PDF icon SOF High Deductible Health HMO Plan SBC.pdf

Members

2020 SOF Standard HMO Plan SBC

PDF icon SOF Standard HMO Plan SBC.pdf

Agents, Employers

2020 Standard Option I 103050 SBC

PDF icon Standard Option 1.pdf

Medicare, Members

2020 State of Florida Benefit Summary

PDF icon 2020 SOF Benefits Summary_revised.pdf

Medicare

2020 State of Florida Comparison

PDF icon 2020 SOF RA Plan Comparison Sheet.pdf

Medicare

2020 State of Florida Retiree Advantage Evidence of Coverage

PDF icon 2020- EOC- SOF Retiree-Advantage-replacement II.pdf

Agents, Employers

2020 Tiered PCP 153050 SBC

PDF icon Tiered PCP Selection 15.30.50.pdf

Agents, Employers

2020 Tiered PCP No Rx SBC

PDF icon 2020 - Tiered PCP Selection - No Rx.pdf

2020 FEHB Benefits Brochure

PDF icon 2020 FEHB Benefits Brochure.pdf

Agents, Employers

3101 - Platinum 153050 2020

PDF icon 3101 Platinum 2020.pdf

Agents, Employers

3102 - Platinum 204060 2020

PDF icon 3102 Platinum 2020.pdf

Agents, Employers

3104 - Gold 2065100 2020

PDF icon 3104 Gold 2020.pdf

Agents, Employers

3106 - Gold 156080 2020

PDF icon 3106 Gold 2020.pdf

Agents

Agent Appointment Application

PDF icon Agent Appointment Application.pdf

Agents

Agent Partner Guide

PDF icon 2019_01_004_agent_guide_final_web.pdf

Agents, Employers, Members

Amwell Frequently Asked Questions

PDF icon Amwell FAQ General.pdf

Agents, Employers, Members

Amwell Quick Start Guide

PDF icon Amwell Quick Start Guide.pdf

Medicare, Providers

Anesthesia and Facility Charges for Dental Services MCR

PDF icon Anesthesia and Facility MCR.pdf

Application Form

PDF icon Application Form.pdf

Application Process Guidelines

PDF icon Application Process Guidelines.pdf

Providers

Applied Behavioral Analysis (ABA) Services Com

PDF icon Applied Behavior Analysis (ABA) Services.pdf

Medicare

Appointment of Representative Form

PDF icon appointment-of-representative-form.pdf

Medicare, Members

Authorization to Use or Disclose Protected Health Information

PDF icon Authorization to Disclose PHI_FILLABLE.pdf