Notices and Forms

Affidavit of Domestic Partner

Beyond Your Benefits

Creditable Coverage Disclosure

Medicare Enrollees

Declination of Healthcare Coverage Affidavit

Dependent Documentation Requirements

Domestic Partner Eligibility

Newly Eligible Adult Child Dependent Package

Social Security Notice

Creditable Part D Notice

Are you Enrollment Ready?

Your enrollment journey begins here. Click the Learn More link below for a smooth enrollment.

Employee Groups

Making an informed enrollment decision is important. Start by selecting your employee group to review your benefit options.

Enrollment Tools & Resources

TheĀ tools and resourcesĀ that will help you get the most out of your benefits.

Notices & Forms

Review your plan document, notices or download the forms you need.

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Office of Risk and Benefits Management
1501 N.E. 2nd Avenue, Suite 335
Miami, Florida 33132
Mon - Fri, 8 a.m. to 4:30 p.m. ET
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305-995-7129

FBMC Service Center
Mon - Fri, 7 a.m. to 7 p.m. ET
1-855-MDC-PS4U (1-855-632-7748)