For your convenience, all benefit forms are now available online. Each form comes in an easy to read and use pdf format.

The forms maybe completed in one of two ways:

  1. Print the form and complete by hand, OR;
  2. Complete the form on your computer, then print and sign.

Send completed forms via interoffice mail, postal service, or in person, to the County’s benefits staff representative listed in the Contact information of this website. FORMS MAY NOT BE ELECTRONICALLY TRANSMITTED


Florida Blue

Health Application

For NEW Enrollment, please read plan coverage terms and complete ALL sections of this form.

Download Form

formulario de descarga

Health Change

When covered employees need to make a change to their coverage or add/delete dependent(s).

Download Form

formulario de descarga

In-Network Providers

Find a provider that accepts your plan.

Find Doctors

Care Centrix

DME and Supplies

Rx Forms

Claims and Orders

HIPAA Authorization

Release Form and Definition

Enrolling and Payments

PLease read the FAQ and if you do not find something specifi,call us

iff you didn’t make a payment when you applied for coverage, you’ll need to make your payment in full before your coverage will start. Look for a payment letter and a bill in the mail. It takes up to 10 days to process your payment. If your payment is still processing when your coverage takes effect and you need care right away, there will be a few extra steps to verify your payment and coverage first. Pay by phone or online 24/7 Call: 1-800-352-2583 Visit: You can pay with a credit card, a debit card or by electronic funds transfer (EFT). Follow the prompts and select the option ‘Make a Payment’. You’ll need Member Number Social Security Number Zip Code Birthdate Bank or credit card information Learn more.

5 ways: Autopay, Online, Call 800-352-2583 and say “Pay my bill.” Mail or In Person Learn more.

1. Activate your member account at Get your health information 24/7 and on the go—and get the inside scoop on members-only special offers that come along.
Go to Click LOG IN and then New User Registration. Enter your member ID number (shown on your bill or ID card), and complete a few steps.
The website is available in English and Spanish. If you have a disability or prefer help in another language, please call 800-352-2583.,

2. Take charge! Everything you need is now at your fingertips!,
Go to My Account to review your profile. Make sure your phone number, address and email are correct. Choose "electronic communications" to avoid a lot of mail and get information in real time. You can also pay your bill, view or print ID cards, check benefits and more – from your home PC or any mobile device.

3. Set up autopay Set it and go, so you don’t have to worry about missing a payment. Simply log in and follow the prompts to "pay my bill" and set up autopay.
Learn more.

If you are a new member or select a new Florida Blue health plan, you will receive a new member ID card with your plan documents or you may receive the card in a separate envelope. If you change plans, but your plan name did not change, you will not receive a new card automatically. This is because your benefit information is stored in the magnetic stripe on the back of the card. Remember, you can print paper ID cards at any time through your online account and view your ID card from any mobile device using the Florida Blue mobile app.Learn more.

Pharmacy FAQs

Please read the FAQ and if you do not find something specific,call us

Use a pharmacy that is in your plan’s network and Preferred Generic drugs (when available) to lower your cost (see your cost now by using our Drug Pricing tool). Using home delivery for ongoing maintenance medication may also save you money.Learn more.

Some drugs may require your doctor to submit a prior authorization before they’re covered

Some drugs may be limited in the amount you can fill within thirty days, unless a special approval is obtained

For plans that cover brand name drugs, certain brand name drugs may not be covered or will cost you more unless you have tried the generic alternative first

Many specialty drugs require a Prior Authorization and must be purchased from our Specialty Pharmacy network, to pay the lowest amount. Call Alliance Rx Walgreens Prime at 1-877-627-6337 or Caremark at 1-866-278-5108 for more information

When you’re outside the state of Florida, take your prescription to a pharmacy that participates in our National Pharmacy Network. Learn more.

Simply complete the claim form , attach your receipt and send to the address indicated on the form. Learn more.

You have two reimbursement options:
1) If you return to the pharmacy with your ID card within one week of your purchase, most pharmacies will rerun the prescription claim and reimburse the amount owed to you. ,
2) You can complete a Prescription Drug Program Claim form, attach your receipt(s) and send to the address shown on the form.
Reimbursement will be based on our contracted rate (what we pay participating pharmacies), less the amount of your applicable copayment or deductible and/or coinsurance. Learn more.

Claims & Health Statements FAQs

Please read the FAQ and if you do not find something specific, call us

You can log in to your member account at or call the Customer Service number on your member ID card. Learn more.

When you’re in the United States and choose doctors or hospitals that participate in our BlueCard program, the health care provider will submit claims on your behalf. When you visit a non-participating provider throughout the U.S.and providers outside the U.S., you may be responsible for filing your claims. Learn more.

Please carefully review the attached notice and keep it on file as it provides important details about the obligations of health plans and your rights in regard to your health information. Learn more.

A Member Health Statement is a summary of finalized health and pharmacy claims for the prior month. This statement shows how claims were paid and what amounts you may be responsible for paying. Learn more.