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Forms and Brochures — Group ProductsThis Forms and Brochures — Group Products section provides you with easy access to the materials you will need to fill prescriptions in a retail pharmacy or by mail order. You will also find forms you can use if you wish to appeal a provision of your plan. Quick links to prescription drug claim formsUse the list below to download the right prescription drug claim form: |
Compare Drug PlansMarch 20, 2010
This page last updated and accepted by CMS January, 2010.
MedicareBlue Rx (PDP) is a Medicare-approved Part D sponsor. MedicareBlue PPO (Regional PPO) is a Medicare-approved regional PPO plan.
Coverage is available to residents of the service area or members of an employer or union group and separately issued by one of the following plans: Wellmark Blue Cross and Blue Shield of Iowa,* Blue Cross and Blue Shield of Minnesota,* Blue Cross and Blue Shield of Montana,* Blue Cross and Blue Shield of Nebraska,* Blue Cross Blue Shield of North Dakota,* Wellmark Blue Cross and Blue Shield of South Dakota,* and Blue Cross Blue Shield of Wyoming.*
*Independent licensees of the Blue Cross and Blue Shield Association.
© 2010. All rights reserved.
R5566_121109_B01 RE CMS 01/10
S5743_121109_B02 RE CMS 01/10