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Health, Dental and Life Insurance Benefits
Refer to your Blue Cross Blue Shield medical plan document for details regarding your coverage. It is the covered person’s
responsibility to know the plan – review your plan benefits, eligibility provisions and any requirements you must follow
in order to receive the maximum allowance for covered services. The provider directories are to be used as a guide only.
Provider participation can change at any time. It is the covered person’s responsibility to verify with their providers
that the provider is a current participant with Blue Cross Blue Shield prior to scheduling appointments and at the time of
service.
Medical Plan Document
Click
here to download the
BlueOption Benefit Booklet for Covered Plan Participants of the City of
Hollywood Group Health Plan.
Dental Plan Document
Click here to view the Benefit Booklet for
the City of Hollywood Comprehensive Plan ($1,000 Plan Year Maximum per person). Click
here to view the Benefit Booklet for
the City of Hollywood Premium Plan ($2,000 Plan Year Maximum per person). For
participating dental providers, log onto
www.bcbsfl.com/ The
insurance plan for City of Hollywood participants is Dental-BlueDental
Choice & Choice Plus PPO.
Medical and Dental Insurance Enrollment Form
Fulltime employees:
Download Document
Retirees:
Download Document
This form is to be used at open enrollment if changes are to be made
to existing coverage. It is also to be used during the year for a
qualifying event: marriage, divorce, birth or adoption of a child, loss
of coverage of a spouse, registration or de-registration of domestic partner.
Blue
Cross Bulletin
Click here to download the bulletin
that explains access to Traditional Network Providers for Blue Options
and Blue Choice Members.
Blue Options (NetworkBlue) Directory
Click here for directory for hospitals; clinics and medical groups to include urgent care centers;
mental health
services; specialty facilities for ambulatory surgical centers, clinical labs, dialysis, independent diagnostic
testing facilities, physical therapy centers, rehabilitation facilities and skilled nursing facilities;
other
providers for advanced registered nurse practitioners, home health agencies, medical equipment & supplies, nurse
midwives, and prosthetic/orthotic suppliers; and physicians not listed in the traditional network below.
Blue Cross Traditional Network - Physicians Only
Links to BlueCross BlueShield Websites
BlueCross BlueShield of Florida
- This site provides helpful information and tips on health and
wellness issues and provides a forum to have general questions
answered.
MyBlueService - This is an online member self-service website you
can access to review your benefits and check your claims.
Health Dialog - In addition to logging onto this site, you may call
1-877-789-2583 to speak with a health coach about your immediate or
every day health concerns 24 hours a day, 7 days a week.
My Dental Information Manager - Dental coverage is provided by Blue Cross through Florida Combined Life. This site allows you to access your dental information. You may also call 1-877-203-9921 with dental inquiries.
BlueCross BlueShield Forms and Informational Material
Major Medical Form
Download Document
Complete this form for reimbursement of out-of-pocket medical expenses,
to include vision care and wellness-related expenses, you may have
paid.
Dental Claim Form
Download Document
Complete this form for reimbursement of out-of-pocket dental expenses
you may have paid.
Vision
Claim Form
Download Document
Complete this form for
reimbursement of eye glasses, contact lenses and/or exams (subject to
the Calendar Year Maximum of $150 per covered member.)
Prescription Drug Claim Form
Download Document
Complete this form for reimbursement of out-of-pocket prescription drug
expenses you may have paid.
PrimeMail
Pharmacy Mail Order Form
Download Document
Complete this form to order prescriptions (up to 90-day supply)
through the mail.
HIPAA Release Form
Download Document
Complete this form to allow health and life insurance information to be
made available to a designated party.
Dependent Verification Form
Download Document
Complete this form to verify eligibility for certain dependent
children.
Blue365
Download Document
This document provides helpful information concerning the discounted programs available to members.
Fast Facts Information Sheet
Download Document
This document provides an overview of the various services available to
members.
Ceridian - Flexible Spending Accounts
Health Care Reimbursement Form
Download Document
Complete this form for reimbursement of out-of-pocket health care expenses you may have incurred.
Dependent Care Reimbursement Form
Download Document
Complete this form for reimbursement of dependent care expenses.
Quest Diagnostics (laboratory testing)
Appointment Scheduling:
It is easy to schedule an appointment at a time and at a location that is convenient either by calling 888-277-8722 or on line.
www.QuestDiagnostics.com/appointment
Patient Service Center (PSC) Locator:
Find convenient Patient Service Center locations.
www.QuestDiagnostics.com/PSC
Employee
Assistance Program
ComPsych
866-645-1765
http://www.guidanceresources.com
Full time City of Hollywood Employees are eligible to participate in the City’s Employee Assistance
Program (EAP) through ComPsych. Eligible employees and their dependents are entitled to four
free confidential counseling sessions per year. You can call
ComPsych toll-free at 866-645-1765, 24
hours a day, 365 days a year, to be connected to the information you need when you need it.
EAP offers counseling and consultation in areas such as:
- Stress Management
- Time Management
- Financial Planning
- Child and Elder Care
- Personal Issues (marital or family conflict, depression, substance abuse)
- Career and Retirement Planning
- Supervisory Consultation
- Legal Questions
Group Life Insurance
The City of Hollywood provides basic group term life insurance to all full time employees through Mutual of Omaha Insurance Company. The amount of coverage provided varies by employee classification. In addition, supplemental (voluntary) life insurance for yourself, or dependent life insurance for your spouse and dependents, is available for purchase by employees. Applications for supplemental (voluntary) and/or dependent life will be accepted during Open Enrollment periods or a qualifying event. Applicants for supplemental (voluntary) and/or dependent life will need to complete an Evidence of Insurability Form and may be required to undergo a physical. Mutual of Omaha Insurance Company will notify the City upon approval of your application. All life insurance participants are encouraged to update their beneficiary regularly.
Please download the policy for your employee classification to view coverage details for
Group Term Life and AD&D Insurance
General, Confidential, Grant and Housing
Authority employees
Fire Union employees
Police Union employees
Executive, Management, Technical, Professional and Supervisory Employees
Retirees
Click
here to view coverage details for
Group Voluntary (Supplemental) Term Life Insurance for all eligible employees
Life Insurance Option Form
(Full time Employees only)
Download Document
Note: You must also complete the Evidence of Insurability Form to apply for or increase Supplemental
Life Insurance. Applications for Supplemental Life are subject to approval by Mutual of Omaha Insurance Company.
Dependent Life Insurance Option Form
Download Document
Note: You must also complete the Evidence of Insurability Form to apply for or increase Dependent Life Insurance.
Applications for Dependent Life are subject to approval by Mutual of Omaha Insurance Company.
Evidence of Insurability Form
Download Document
This form is required in addition to the applicable option form to apply for or increase your Supplemental
or Dependent Life Insurance.
Life Insurance
Beneficiary Designation Form
Download Document
Use this form to update your beneficiary information.
Nationwide Deferred Compensation Contribution Change Form
Click here to increase, decrease or stop your
contribution to Nationwide. Once you have completed the form, send the original to
Human Resources and keep a copy for your file.
Agency for Healthcare Research and Quality (AHRQ)
The Consumers and Patients page, sponsored by the Agency for Healthcare Research and
Quality (AHRQ), U.S. Department of Health and Human Services, offers resources to help
individuals with their health care needs. By clicking the link below, you will find tools
which will include information on specific diseases and conditions, recommendations for
choosing health care services, tips for staying healthy, and other tools that can be
useful in assessing and improving the quality of care you and your family receive.
www.ahrq.gov/consumer/
Frequently Asked Questions Upon Termination of Employment
Click here to view answers to questions that employees frequently ask when their employment with the City of Hollywood is terminated.
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