Health, Dental, Life and Vision Insurance Benefits
The City of Hollywood offers full-time and eligible part-time employees PPO health plan coverage through Florida Blue (previously known as BlueCross BlueShield of Florida).
If you have any questions regarding Florida Blue health plan services, please contact customer service 877.352.2583 or log-in to www.floridablue.com.
If you have questions regarding your eligibility with the plan, please contact the Office of Human Resources at 954.921.3578.
Participating medical providers can be found on floridablue.com under 'Find a Doctor'
Medical and Dental Insurance Enrollment Form
Full-time 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 a domestic partner.
Click here to view the 2016 Blue Options Benefit Booklet.
Blue Options (NetworkBlue) Directory
Click here for directory for hospitals; clinics and medical groups to include urgent care centers; medical 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 and supplies, nurse midwives, and prosthetic/orthotic suppliers; and physicians not listed in the traditional network.
Instructions to Find Medical Provider
Links to Florida Blue Websites
Florida Blue - This site provides helpful information and tips on health and wellness issues and provides a forum to have general questions answered.
My BlueService - 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 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.
The City of Hollywood offers full-time and eligible part-time employees PPO Dental Insurance. Employees have the option of enrolling into one of two (2) plans: the Comprehensive Plan, which provides a $1,000 maximum benefit per year/per person, or the Premium Plan, which provides for a $2,000 maximum benefit per year/per person.
My Dental Information Manager - Dental coverage is provided by Florida Blue through Florida Combined Life. Participating dental providers can be found on floridablue.com under 'Find a Doctor' or by calling 888.223.4892 with dental inquiries.
Click here to view the Benefits 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.floridablue.com. The insurance plan for the City of Hollywood participants is Dental-Blue Dental Choice & Choice Plus PPO.
If you have questions regarding Florida Combined Life Dental Plan Services, please contact Customer Service at 888.223.4892 .
Instructions to Find Dental Provider
Florida Blue Forms and Informational Materials
2016 Summary of Benefits & Coverage
This document provides the summary of benefits and coverage for the City of Hollywood's medical plan.
2016 Preventive Care Guidelines
This document provides the 2016 Adult and Children preventive care guidelines.
Florida Blue Medical Plan Booklet
Major Medical Form
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
Complete this form for reimbursement of out-of-pocket dental expenses you may have paid.
Prescription Drug Claim Form
Complete this form for reimbursement of out-of-pocket prescription drug expenses you have paid.
PrimeMail Pharmacy Mail Order Form
Complete this form to order prescription (up to 90-day supply) through the mail.
HIPAA Release Form
Complete this form to allow health and life insurance information to be made available to a designated party.
This document provides helpful information concerning the discount programs available to members
Fast Facts Information Sheet
This document provides an overview of the various services available to members.
VSP (Vision Services Provider) is an online based provider and does not provide ID cards. Employees can log on to vsp.com to search for providers, view benefits and print ID Cards. Your social security number is your member ID. VSP Enrollment Form
VSP Option 1 – Detailed benefit information for option 1.
VSP Option 2 – Detailed benefit information for option 2.
VSP Option 3 – Detailed benefit information for option 3.
TASC - Flexible Spending Accounts
Customer Service 800.422.4661 - www.tasconline.com
The City of Hollywood provides flexible spending funds to full time and eligible part time employees. The amount provided is determined by the employee's medical coverage level, employee's classification, and applicable Collective Bargaining Agreements.
FlexSystem Participant Online Enrollment Guide - Instructions on how to log into your TASC account online, view your account balance and submit reimbursements for eligible expenses.
TASC - FlexSystem Eligible Expenses - List of eligible expenses for your Medical and Dependent Care flexible spending accounts.
Voluntary Supplemental Insurance Programs
The City of Hollywood offers voluntary supplemental insurance choices through employee-paid payroll deductions. Note: New employees have 30 days from their date of hire to enroll in these supplemental programs or wait until open enrollment. Benefit changes made during open enrollment will be effective January 1st of the upcoming year. Click here for the Voluntary Supplemental Insurance Programs flyer for more information.
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 866.697.8378 or online at www.QuestDiagnostics.com/appointment.
Patient Service Center (PSC) Locator: Find convenient Patient Service Center locations.
Group Life Insurance
Symetra - www.symetra.com
The City provides Life and Accidental Death and Dismemberment (AD&D) insurance to full time employees.
Value Added Programs Brochure - This document provides a list of discounts and services employees receive in addition to the Life and AD&D coverage through Symetra.
Beneficiary Designation Form
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 Resources, 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.