Documents & Forms Results

Eyewear Reimbursement Form (Medicare)

Request reimbursement for eligible eye care services you've received. For members of Medicare plans.

2026 SecureBlue Summary of Benefits

2026 SecureBlue Summary of Benefits Spanish

SecureBlue Resumen de Beneficios para 2026

2027 SecureBlue Provider and Pharmacy Directory

List of in-network doctors, hospitals, pharmacies and other healthcare providers

2027 SecureBlue Formulary

List of covered drugs and any rules or restrictions that apply

2027 Medicare Advantage Select and Premier and Platinum Blue Choice and Complete Formulary

List of covered drugs

2027 Medicare Advantage and Platinum Blue Part D Pharmacy Directory

List of pharmacies in the Medicare Part D network

2027 Medicare Advantage Essential and Platinum Blue Core Formulary

List of covered drugs

2027 Group Medicare Advantage Pharmacy Directory

List of pharmacies in the Medicare Part D network

2027 Group Medicare Advantage Formulary

For Group Medicare Advantage (PPO) Value Rx 4 plans