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Plans Applicable to

Community Blue Medicare HMO Signature

Community Blue Medicare Plus PPO Distinct

Community Blue Medicare Plus PPO Signature

Community Blue Medicare PPO Signature

Community Blue Medicare PPO Distinct

Complete Blue PPO Distinct

Complete Blue PPO Signature

Freedom Blue PPO Signature (DE)

Freedom Blue PPO Distinct (DE)

Freedom Blue PPO DE Calendar

Freedom Blue PPO DE ASO Calendar

Freedom Blue PPO Prestige (DE)

Freedom Blue PPO WV Calendar

Freedom Blue PPO WV ASO Calendar

Freedom Blue PPO Distinct (WV)

Freedom Blue PPO Standard (WV)

Freedom Blue PPO Signature (WV)

Freedom Blue PPO Merit (WV)

Freedom Blue PPO Prestige (WV)

Freedom Blue PPO ValueRx

Security Blue HMO-POS ValueRx

Together Blue Medicare HMO Signature

Plans Applicable to 

Blue Rx PDP Complete

Blue Rx PDP Plus

Community Blue Medicare HMO Prestige

Community Blue Medicare PPO Premier

Complete Blue PPO Premier

Community Blue Medicare Plus PPO Premier

Freedom Blue PPO Classic

Freedom Blue PPO Deluxe

Freedom Blue PPO Select

Freedom Blue PPO Standard

Security Blue HMO-POS Deluxe

Security Blue HMO-POS Standard