Anthem Blue MedicareRx Part D - Nevada

• Blue MedicareRx Summary of Benefits:

• Blue MediCareRx Summary of Benefits Printable

• Blue MedicareRx Value Plan - Evidence of Coverage Printable
• Blue MedicareRx Plus Plan - Evidence of Coverage Printable
• Blue MedicareRx Premier Plan - Evidence of Coverage Printable

Forms:

Formulary Transition Notice

Prior Authorization Criteria

Request Form - Coverage Determination, Formulary Exception or Tiering Exception: Medicare Part D enrollees can use this form to request coverage determinations (including tiering or formulary exception requests) from their Medicare Part D plan sponsor.

Conditions and Limitations: By law, certain types of drugs or categories of drugs are not covered by Medicare Prescription Drug Plans. These drugs or categories of drugs are called "exclusions".

Out of Network Prescription Drug Coverage: Review the procedures for filling prescriptions outside of the network

Paper Claim Form for Prescription Drugs

Prescription Mail Order Forms
For more information on how this mail order program works and to download and complete the mail order form:
Prescription Mail Order Service

• Order the Application

• Anthem Medicare Supplement Application Downloadable & Printable Application

• Unicare SecurityChoice PFFS - Any age on Medicare A & B part - Private Fee-for-Service Unicare SecurityChoice Monthly plan premiums range from $0 to $91 depending on which plan you select and your county of residence. (You must continue to pay your Medicare Part B premiums no matter which plan you choose.)

• Order the Application

Anthem Blue MedicareRx - Nevada