Florida PHP

The following publications and forms are for plan members. All publications below are applicable to the plan year indicated. If you need a publication or form that is not listed below, please contact Member Services. If you would like a printed copy of any of the documents below, please contact Member Services.

2023 Plan Publications

• 2023 Summary of Benefits
• 2023 Quality and Performance Ratings (Every year, Medicare evaluates plans based on a 5-star rating system.)
• 2023 Annual Notice of Change (ANOC)
• 2023 Evidence of Coverage
• 2023 Comprehensive Formulary (effective May 1, 2023; last updated April 25, 2023)
• 2023 Prescription Drug Prior Authorization Criteria (effective May 1, 2023; last updated April 25, 2023)
• 2023 Prescription Drug Step Therapy Criteria (effective May 1, 2023; last updated April 25, 2023)

Provider and Pharmacy Directories

• Search online using our Network Provider/Facility/Pharmacy Search application
• Provider and Part B Pharmacy Directory – Broward and Miami-Dade Counties (last updated April 1, 2023)
•  Provider and Part B Pharmacy Directory – Duval County (last updated April 1, 2023)
• Part D Pharmacy Directory – Broward and Miami-Dade Counties (last updated April 1, 2023)
• Part D Pharmacy Directory – Duval County (last updated April 1, 2023)

Other Publications and Forms

• Appointment of a Representative Form and Information
• Notice of Privacy Practices
• Health and Wellness Benefit Option Election Form
  • Broward and Miami-Dade Counties
  • Duval County
• Over-the-Counter Pharmacy Order Form (effective April 13, 2020)
• Enrollee Demographics Questionnaire

You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.