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Plan Forms
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2022 Blue Medicare HMO Medical Only EOC
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2022 Blue Medicare HMO Choice EOC
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2022 Blue Medicare HMO Enhanced EOC
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2022 Blue Medicare HMO Enhanced EOC 024-002 and 003
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2022 Blue Medicare HMO Essential Plus 023-001 EOC
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2022 Blue Medicare HMO Essential Plus 023-002
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2022 Blue Medicare HMO Essential Plus 023-004 and 005 EOC
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2022 Blue Medicare PPO Enhanced EOC 003-001
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2022 Blue Medicare PPO Enhanced EOC 003-002
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2022 Blue Medicare Rx (PDP) Standard EOC
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2022 Blue Medicare Rx (PDP) Enhanced EOC
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2022 Blue Medicare Freedom+ PPO EOC
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2022 Blue Medicare HMO Essential 027-001 EOC
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2022 Blue Medicare HMO Essential 027-002 EOC
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2022 Healthy Blue + Medicare (HMO D-SNP) EOC
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2022 Blue Medicare HMO Medical Only ANOC
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2022 Blue Medicare HMO Choice ANOC
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2022 Blue Medicare HMO Essential Plus 023-001 ANOC
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2022 Blue Medicare HMO Essential Plus 023-002 ANOC
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2022 Blue Medicare HMO Essential Plus 023-004 ANOC
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2022 Blue Medicare HMO Essential Plus 023-005 ANOC
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2022 Blue Medicare HMO Essential Plus 023-004 to 002
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2022 Blue Medicare HMO Essential Plus 023-005 to 001
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2022 Blue Medicare HMO Essential Plus 023-005 to 004
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2022 Blue Medicare HMO Enhanced 024-001 ANOC
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2022 Blue Medicare HMO Enhanced 024-002 ANOC
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2022 Blue Medicare HMO Enhanced 024-003 ANOC
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2022 Blue Medicare HMO Enhanced 024-003 to 002
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2022 Blue Medicare PPO Enhanced ANOC 003-002
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2022 Blue Medicare PPO Enhanced 003-001 ANOC
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2022 Blue Medicare PPO Enhanced 003-002 ANOC
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2022 Blue Medicare PPO Enhanced 003-002 to 001
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2022 Blue Medicare Rx (PDP) Standard ANOC
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2022 Blue Medicare Rx (PDP) Enhanced ANOC
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2022 Blue Medicare HMO Essential 027-001 ANOC
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2022 Blue Medicare HMO Essential 027-002 ANOC
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2022 Healthy Blue + Medicare (HMO D-SNP) ANOC
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2022 Healthy Blue + Medicare Star Ratings
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2022 Blue Medicare HMO Star Ratings
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2022 Blue Medicare PPO Star Ratings
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2022 Blue Medicare Rx Star Ratings
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2021 Blue Medicare HMO Star Ratings
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2021 Blue Medicare PPO Star Ratings
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2021 Blue Medicare Rx Star Ratings
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Prescription Drug Forms
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2022 Blue Medicare Rx Standard Prior Authorization (April)
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2022 Blue Medicare Rx Enhanced Prior Authorization (April)
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2022 Blue Medicare PPO Employer Group Complete, Blue Medicare Rx Employer Group Complete, Blue Medicare HMO Employer Group Complete Prior Authorization (March)
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2022 Blue Medicare HMO Employer Group Ideal, Blue Medicare PPO Employer Group Ideal, Blue Medicare Rx Employer Group Ideal Prior Authorization (April)
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2022 Blue Medicare Choice, Blue Medicare Enhanced, Blue Medicare Essential, Blue Medicare Essential Plus, Blue Medicare PPO Enhanced Prior Authorization (April)
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Blue Medicare Rx Standard
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Blue Medicare PPO Employer Group Complete, Blue Medicare HMO Employer Group Complete, Blue Medicare Rx Employer Group Complete (March)
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Blue Medicare Rx Enhanced, Blue Medicare HMO Employer Group Ideal, Blue Medicare PPO Employer Group Ideal, Blue Medicare Rx Employer Group Ideal, Blue Medicare Choice, Blue Medicare Enhanced, Blue Medicare Essential, Blue Medicare Essential Plus, Blue Med
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Proof of Coverage
If your coverage with Blue Cross NC has ended and you need proof of coverage, please call Customer Service number on the back of your Blue Cross NC member ID card. If your coverage is still active, and you need a Certification of Health Insurance Coverage document, please call the Customer Service Number on the back of your Blue Cross NC Blue Medicare Rx ID card.
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