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Anthem Blue Cross and Blue Shield

PW_E207312
 
2014 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  

Blue MedicareRx Standard (PDP) 
SOB  
EOC  
Blue MedicareRx Plus (PDP) 
SOB  
EOC  
Blue MedicareRx Premier (PDP) 
SOB  
EOC  
 
Connecticut  

Anthem MediBlue Preferred Standard (PPO) 
SOB  
EOC  
Anthem MediBlue Value (HMO) 
SOB  
EOC  
 
Indiana  

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

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

Anthem Medicare Preferred Premier (PPO) 
SOB  
EOC  
Anthem MediBlue Select (HMO) 
SOB  
EOC  
Blue MedicareRx Plus (PDP) 
SOB  
EOC  
Blue MedicareRx Premier (PDP) 
SOB  
EOC  
Blue MedicareRx Standard (PDP) 
SOB  
EOC  
 
Missouri  

Anthem Medicare Preferred Core (PPO)1 
SOB  
EOC  
Anthem Medicare Preferred Core (PPO)2 
SOB  
EOC  
Anthem MediBlue Select (HMO) 
SOB  
EOC  
Blue MedicareRx Value (PDP) 
SOB  
EOC  
Blue MedicareRx Plus (PDP) 
SOB  
EOC  
Blue MedicareRx Premier (PDP) 
SOB  
EOC  
 
New Hampshire  

Anthem Medicare Preferred Premier (PPO) 
SOB  
EOC  
Anthem MediBlue Select (HMO) 
SOB  
EOC  
Blue MedicareRx Plus (PDP) 
SOB  
EOC  
Blue MedicareRx Premier (PDP) 
SOB  
EOC  
Blue MedicareRx Standard (PDP) 
SOB  
EOC  
 
Nevada  

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

Anthem Senior Advantage Basic (HMO)3 
SOB  
EOC  
Anthem Senior Advantage Basic (HMO)4 
SOB  
EOC  
Anthem Senior Advantage Plus (HMO)5 
SOB  
EOC  
Anthem Senior Advantage Plus (HMO)6 
SOB  
EOC  
Anthem Medicare Preferred Standard (PPO)7 
SOB  
EOC  
Anthem Medicare Preferred Standard (PPO)8 
SOB  
EOC  
Anthem Medicare Preferred Select (PPO)9 
SOB  
EOC  
Anthem Medicare Preferred Select (PPO)10 
SOB  
EOC  
Blue Medicare Access Classic (Regional PPO) 
SOB  
EOC  
 
Blue Medicare Access Value (Regional PPO) 
SOB  
EOC  
Blue MedicareRx Standard (PDP) 
SOB  
EOC  
Blue MedicareRx Plus (PDP) 
SOB  
EOC  
Blue MedicareRx Premier (PDP) 
SOB  
EOC  
 
Virginia  

Anthem Medicare Preferred Core (PPO)11 
SOB  
EOC  
Anthem Medicare Preferred Core (PPO)12 
SOB  
EOC  
Anthem HealthKeepers MediBlue (HMO D-SNP) 
SOB  
EOC  
Blue MedicareRx Standard (PDP) 
SOB  
EOC  
Blue MedicareRx Plus (PDP) 
SOB  
EOC  
Blue MedicareRx Premier (PDP) 
SOB  
EOC  
Blue MedicareRx Standard CareFirst (PDP) 
SOB  
EOC  
Blue MedicareRx Plus CareFirst (PDP) 
SOB  
EOC  
Blue MedicareRx Premier CareFirst (PDP) 
SOB  
EOC  
 
Wisconsin  

Anthem Medicare Preferred Core (PPO) 
SOB  
EOC  
Anthem Medicare Preferred Standard (PPO)13 
SOB  
EOC  
Anthem Medicare Preferred Standard (PPO)14 
SOB  
EOC  
Anthem MediBlue Select (HMO)15 
SOB  
EOC  
Anthem MediBlue Select (HMO)16 
SOB  
EOC  
Blue MedicareRx Standard (PDP) 
SOB  
EOC  
Blue MedicareRx Plus (PDP)  
SOB  
EOC  
Blue MedicareRx Premier (PDP) 
SOB  
EOC  
 
BlueCross BlueShield of Kansas  

Blue MedicareRx Value (PDP) 
SOB  
EOC  
Blue MedicareRx Plus (PDP) 
SOB  
EOC  
Blue MedicareRx Premier (PDP) 
SOB  
EOC  
 
BlueCross BlueShield of Kansas City  

Blue MedicareRx Value (PDP)17 
SOB  
EOC  
Blue MedicareRx Plus (PDP)17 
SOB  
EOC  
Blue MedicareRx Premier (PDP)17 
SOB  
EOC  
       
Blue MedicareRx Value (PDP)18 
SOB  
EOC  
Blue MedicareRx Plus (PDP)18 
SOB  
EOC  
Blue MedicareRx Premier (PDP)18 
SOB  
EOC  
 
1Christian, Dade, Dallas, Douglas, Greene, Jasper, Lawrence, Newton, Polk, St. Charles, St. Louis, St. Louis City, and Webster Counties 
2Ozark, Warren, and Wright Counties 
3Belmont, Brown, Butler, Carroll, Columbiana, Delaware, Franklin, Greene, Hamilton, Lucas, Mahoning, Miami, Montgomery, Muskingum, Portage, Preble, Stark, Summit, Trumbull, Tuscarawas, Union, and Wood Counties 
4Ashland, Clark, Clermont, Cuyahoga, Darke, Fairfield, Fulton, Geauga, Lake, Licking, Madison, Medina, Ottawa, and Warren Counties 
5Belmont, Brown, Butler, Carroll, Columbiana, Delaware, Franklin, Greene, Hamilton, Lucas, Mahoning, Miami, Montgomery, Muskingum, Portage, Preble, Stark, Summit, Trumbull, Tuscarawas, Union, and Wood Counties 
6Shelby County 
7Belmont, Carroll, Columbiana, Cuyahoga, Delaware, Geauga, Greene, Lake, Miami, Montgomery, Muskingum, Preble, Stark, Summit, and Trumbull Counties 
8Ashland, Brown, Clermont, Franklin, Hancock, Licking, Lucas, Madison, Mahoning, Medina, Portage, Shelby, Tuscarawas, Warren, Wayne, and Wood Counties 
9Belmont, Carroll, Columbiana, Cuyahoga, Delaware, Geauga, Greene, Lake, Miami, Montgomery, Muskingum, Preble, Stark, Summit, and Trumbull Counties 
10Hamilton, Lorain, and Sandusky Counties 
11Roanoke City County 
12Mathews County 
13Columbia, Dodge, Marathon, Marinette, Oconto, Portage, Waupaca, and Waushara Counties 
14Milwaukee and Waukesha Counties 
15Milwaukee and Waukesha Counties 
16Kenosha and Racine Counties 
17Kansas 
18Missouri  
 
©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