2022 Annual Notice of Change/Evidence of Coverage
The Evidence of Coverage booklet tells you how to get your Medicare medical care and prescription drugs (if applicable) through a Medicare Advantage plan.
The Evidence of Coverage booklet explains:
- Member rights and responsibilities
- What is covered
- What you will pay as a member of the plan
The benefits listed in the Evidence of Coverage are effective January 1 of the current year. Benefits, formulary, pharmacy network, premium and/or copayments/co-insurance may change on January 1, 2022.
Medicare Advantage HMO Plans
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2022 Senior Blue Basic (HMO) Evidence of Coverage Last updated October 4, 2021
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2022 Senior Blue 601 (HMO) Evidence of Coverage Last updated October 4, 2021
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2022 Senior Blue 601 (HMO) Annual Notice of Change Last updated October 1, 2021
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2022 BlueSaver (HMO) Evidence of Coverage Last updated October 4, 2021
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2022 BlueSaver (HMO) Annual Notice of Change Last updated October 1, 2021
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2022 Senior Blue Select (HMO) Evidence of Coverage Last updated October 4, 2021
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2022 Senior Blue Select (HMO) Annual Notice of Change Last updated October 1, 2021
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2022 Senior Blue 651 (HMO) Evidence of Coverage Last updated October 4, 2021
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2022 Senior Blue 651 (HMO) Annual Notice of Change Last updated October 1, 2021
Medicare Advantage PPO Plans
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2022 Freedom Nation (PPO) Evidence of Coverage Last updated January 18, 2022
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2022 Freedom Nation (PPO) Annual Notice of Change Last updated October 1, 2021
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2022 Forever Blue Value (PPO) Evidence of Coverage Last updated October 4, 2021
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2022 Forever Blue Value (PPO) Annual Notice of Change Last updated October 1, 2021
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2022 Forever Blue 751 (PPO) Evidence of Coverage Last updated October 4, 2021
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2022 Forever Blue 751 (PPO) Annual Notice of Change Last updated October 1, 2021
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Highmark Blue Cross Blue Shield of Western New York (Highmark BCBSWNY) is a trade name of Highmark Western and Northeastern New York Inc., an independent licensee of the Blue Cross Blue Shield Association. Highmark BCBSWNY is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal. Highmark BCBSWNY complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-833-735-4515 (TTY 711). 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-833-735-4515 (TTY 711).
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Content last updated: January 18, 2022