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Evidence of Coverage

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Medicare Help Center | Documents | Evidence of Coverage

If you're a member of one of our individual Medicare Advantage or Part D prescription drug plans, these books explain how your plan works.

Your stove, furnace, car, T.V. and cell phone all come with an instruction manual. So do our Medicare Advantage and Prescription Blue℠ PDP plans. It's called your Evidence of Coverage and it's our contract with you. It also has lots of helpful information you need to know about using your plan. You can find yours here.

Medicare Plus Blue℠ PPO

This book is for members of these Medicare Plus Blue PPO plans:

  • Essential
  • Vitality
  • Signature
  • Assure

Evidence of Coverage (PDF)

BCN Advantage℠ HMO and HMO-POS

Not sure which plan you have? Call the Customer Service number on the back of your Blues ID card and we'll help.

Plan name Document
BCN Advantage HMO Local  (Wayne County only) Evidence of Coverage (PDF)
BCN Advantage HMO MyChoice Wellness  (Kent, Muskegon and Oceana counties only) Evidence of Coverage (PDF)
BCN Advantage HMO-POS plans: Basic, Classic and Prestige Evidence of Coverage (PDF)
BCN Advantage HMO-POS Elements
Evidence of Coverage (PDF)

Prescription Blue PDP plans

This book is for both Option A and Option B prescription drug plans.

Evidence of Coverage (PDF)

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Page Last Updated Tue Jun 24 11:03:42 EDT 2014