Medical Plan Document Click here to download the BlueOption Benefit Booklet for Covered Plan Participants of the City of Hollywood Group Health Plan.

Medical and Dental Insurance Enrollment Form (full time employees only)
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This form is to be used by eligible employees at open enrollment if they wish to make changes to their existing coverage. It is also to be used by eligible employees 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 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.

BlueCross BlueShield Forms and Informational Material

Major Medical Form
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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
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Complete this form for reimbursement of out-of-pocket dental expenses you may have paid.

Vision Claim Form
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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
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Complete this form for reimbursement of out-of-pocket prescription drug expenses you may have paid.

PrimeMail Pharmacy Mail Order Form
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Complete this form to order perescriptions (up to 90-day supply) through the mail.

HIPAA Release Form
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Complete this form to allow health and life insurance information to be made available to a designated party.

Dependent Verification Form
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Complete this form to verify eligibility for certain dependent children.

Blue Complements Information Sheet and Poster
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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
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This document provides an overview of the various services available to members.