Welcome to the City of Hollywood Office of Human Resources & Risk Management

Employee Benefits


All documents are in Adobe Reader (PDF) format. If you do not have the free Adobe Reader, click here. 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 South Florida (pdf) Central Florida (pdf) Northeast Florida (pdf) Northwest Florida (pdf) West Coast Florida (pdf) Outside the State of Florida, call 1-800-810-BLUE (2583) 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. 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. Flexible Spending Account - Health Expense Reimbursement Request Form Download Document Complete this form for out-of-pocket health care expenses you may have incurred. Flexible Spending Account - Dependent Care Reimbursement Request Form Download Document Complete this form for reinbursement of dependent care expenses. Flexible Spending Account - Direct Deposit Authorization Form Download Document Complete this form to authorize Blue Cross and Blue Shield of Florida to credit or debit entries to your checking account. 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. Blue Complements Information Sheet and Poster Download Document This document provides helpful information concerning the discounted program available to members; the poster provides key telephone numbers for the programs. Fast Facts Information Sheet Download Document This document provides an overview of the various services available to members. 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 Fort Dearborn Life Insurance Company. The amount of coverage provided varies by employee classification. Additional supplemental life insurance is available for purchase by employees. Applications for supplemental life will be accepted during Open Enrollment periods only. Applicants for additional life will need to complete an Evidence of Insurability application and may be required to undergo a physical. Fort Dearborn Life Insurance Company will notify the City upon approval of your application. All life insurance participants are encouraged to update their beneficiary regularly. Life Insurance Option Form (Full time Employees only) Download Document Note: You must also complete the Evidence of Insurability Application to increase your Supplemental Life. Increases in Supplemental Life are subject to approval by Fort Dearborn Life Insurance Company. Dependent Life Insurance Option Form Download Document Note: You must also complete the Evidence of Insurability Application to increase your Dependent Life. Increases in Supplemental Life are subject to approval by Fort Dearborn Life Insurance Company. Evidence of Insurability Form Download Document This form is required in addition to the applicable option form to 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. Requirements: You must have Adobe Reader Click here to download Adobe Reader.


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