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Anthem Blue Cross and Blue Shield

PW_E179236
 
2012 Medicare Advantage Summary of Benefits (SOB), Evidence of Coverage (EOC) and Formularies for Individual Medicare Advantage Products. If the product you are searching for is not on the list below, then please call the number on the back of the member’s ID card for EOC, SOB, and Formulary information. 
Colorado  

SureValue Basic (HMO)  
SOB  
EOC  
Anthem Medicare Preferred Core (PPO) 
SOB  
EOC  
Anthem Medicare Preferred Premier (PPO) 
SOB 
EOC 
Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Premier (PDP)  
   
Blue MedicareRx Standard (PDP)  
   
 
Connecticut  

MediBlue Plus (HMO)  
SOB  
EOC  
Anthem Medicare Preferred Standard (PPO) 
SOB  
EOC  
 
Indiana  

Anthem Medicare Preferred Standard (PPO)  
SOB  
EOC  
Anthem Medicare Preferred Select (PPO)  
SOB  
EOC  
Blue Medicare Access Value (Regional PPO)  
SOB  
EOC  
Blue Medicare Access Standard (Regional PPO) 
SOB  
EOC  
Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Premier (PDP)  
   
Blue MedicareRx Standard (PDP)  
   
 
Kansas  

Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Premier (PDP)  
   
Blue MedicareRx Value (PDP)  
   
Blue MedicareRx Plus (PDP Kansas City KS)  
   
Blue MedicareRx Premier (PDP Kansas City KS)  
   
Blue MedicareRx Value (PDP Kansas City KS)  
   
 
Kentucky  

Anthem Senior Advantage Complete (HMO)  
SOB  
EOC  
Anthem Senior Advantage Value (HMO)  
SOB  
EOC  
Anthem Medicare Preferred Standard (PPO)  
SOB  
EOC  
Anthem Medicare Preferred Select (PPO) 
SOB 
EOC 
Blue Medicare Access Value (Regional PPO)  
SOB  
EOC  
Blue Medicare Access Standard (Regional PPO)  
SOB  
EOC  
Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Premier (PDP)  
   
Blue MedicareRx Standard (PDP)  
   
 
Maine  

Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Premier (PDP)  
   
Blue MedicareRx Standard (PDP)  
   
 
Missouri  

Anthem Medicare Preferred Core (PPO)  
SOB  
EOC  
Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Premier (PDP)  
   
Blue MedicareRx Value (PDP)  
   
Blue MedicareRx Plus (PDP Kansas City MO)  
   
Blue MedicareRx Premier (PDP Kansas City MO)  
   
Blue MedicareRx Value (PDP Kansas City MO)  
   
 
Nevada  

Anthem Medicare Preferred Core (PPO)  
SOB  
EOC  
Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Premier (PDP)  
   
Blue MedicareRx Standard (PDP)  
   
 
New Hampshire  

Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Premier (PDP)  
   
Blue MedicareRx Standard (PDP)  
   
 
Ohio  

Anthem Senior Advantage Basic (HMO)  
SOB  
EOC  
Anthem Senior Advantage Plus (HMO)  
SOB  
EOC  
Anthem Senior Advantage Value (HMO)  
SOB  
EOC  
Anthem Medicare Preferred Standard (PPO)  
SOB  
EOC  
Anthem Medicare Preferred Select (PPO)  
SOB  
EOC  
Blue Medicare Access Classic* (Regional PPO)  
SOB  
EOC  
 
Blue Medicare Access Value (Regional PPO)
*No Part D is sold with this product 
SOB  
EOC  
Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Standard (PDP)  
   
 
Virginia  

Anthem Medicare Preferred Standard (PPO)  
SOB  
EOC  
Anthem Medicare Preferred Premier (PPO)  
SOB  
EOC  
Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Premier (PDP)  
   
Blue MedicareRx Standard (PDP)  
   
 
Wisconsin  

Anthem Medicare Preferred Core (PPO)  
SOB  
EOC  
Anthem Medicare Preferred Select (PPO)  
SOB  
EOC  
Blue MedicareRx Plus (PDP)  
   
Blue MedicareRx Premier (PDP)  
   
Blue MedicareRx Standard (PDP)  
   
 
Additional Part D Forms 

     
     
     
     
     
     
©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