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PW_AD094674
Anthem HMO Plan Brochure

Colorado (SureValue)

Connecticut (MediBlue HMO) For more information on the MediBlue HMO prescription drug benefit, click here

Indiana (Anthem Senior Advantage)

Kentucky (Anthem Senior Advantage)

Missouri (Anthem Senior Advantage)

Ohio (Anthem Senior Advantage)

Wisconsin (Anthem Senior Advantage)

 
Enrollment Materials
 
Anthem HMO Summary of Benefits

Colorado (SureValue)

Connecticut (MediBlue HMO)

Indiana (Anthem Senior Advantage)

Kentucky (Anthem Senior Advantage)

Missouri (Anthem Senior Advantage)

Ohio (Anthem Senior Advantage)

Wisconsin (Anthem Senior Advantage)

 
Evidence of Coverage

Anthem Senior Advantage – Basic, Enhanced

Missouri – Anthem Senior Advantage Enhanced

Colorado – SureValue

Connecticut – MediBlue HMO Essential, Plus, Select

 
Limited Income Subsidy (LIS)
Anthem Senior Advantage Prescription Drug Formulary
MediBlue HMO Prescription Drug Formulary
SureValue Prescription Drug Formulary
Formulary Transition Notice
Grievance & Appeals Information (for plans with prescription drug benefits)
Request Form - Coverage Determination, Formulary Exception or Tiering Exception
Quality Assurance (for plans with prescription drug benefits)
Appointment of Representative Form
Prescription Drug Claim Form
Prescription Drug Claim Form (CT Only)
 
If you are interesting in getting more information about Anthem Medicare Preferred, contact your Anthem agent or click here to contact Anthem’s New Enrollment department. 
 
CMS Approved Date 10/2007, Material Identification M0013_08_159
Last Updated 06/2008  
 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use