850.747.0288 admin@bayinspc.com





Insurance Provider Forms

Please see the insurance forms below.



Blue Cross Blue Shield of Florida


Authorization Form

Authorization to release "Protected Health Information"

Employee Application

Blue Cross Blue Shield Health and Financial Enrollment Application

Major Medical Claim Form

For submitting claims for services and supplies that are not submitted by your provider.

Prescription Drug Claim Form

Prescription Drug Program Subscriber Claim Form

PrimeMail Order Form

New Prescription PrimeMail Order Form for Blue Cross Blue Shield of Florida

Medicare PrimeMail Order Form

New Prescription PrimeMail Order Form for Medicare



Guardian Insurance


Guardian Enrollment Form

Enrollment Application for Guardian Insurance



Metlife Insurance


Metlife Enrollment Form

Enrollment for Group Insurance

Metlife Change Request Form

Name Change, Address Change, Add Dependant



Ohio National Insurance


Ohio National Beneficiary Information Sheet

Add a Beneficiary to your Insurance Policy

Ohio National Beneficiary Change Request Form

This form offers the ability to make changes on your policy plan



United Concordia Dental


United Concorida Form

Enrollment Application Form




Request A FREE Quote





Contact Info


Nichols & Associates of Bay County, Inc.

1229 Jenks Avenue

Panama City, Florida 32401


Phone 850.747.0288

Fax 850.747.1464






Insuring Lives. Enriching Futures.


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