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


IF YOU NEED ASSISTANCE WITH A HEALTH COVERAGE OR A CLAIM ISSUE, CONTACT 850-266-7939 at 850-266-7939.



BlueCrossBlueShield / Florida Blue Forms


Health Application

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

Download Form

Health Change

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

Download Form

Providers

Find a provider that accepts your plan.

Go to Site

Summary of Benefits

Plans Summary

Enrollment Rights

Notice of Special Enrollment Rights

Download Form

BCBS Handbook

Enrollment Guide for Group Employees

PHI Authorization

Authorization to use/access Protected Health Information

Mediscript

Prescription Claim Form

Download Form

Prime Therapeutics

New Information and Fax Order Form

PrimeMail

Order Form

Download Handbook

Rx Forms

Quantity Limit physician fax form and Prior Authorization information



SRCBenefits.com