The following forms are provided for your use. Theyare in Adobe Acrobat (PDF) Format. Click the form name to dowload the desired form.

Health Enrollment Application
 Special Enrollment Rights
 Prime Therapeutics Mail Order & Rx
Health Change Application
Dependent Eligibility Verification
PHI- Protected Health Information
Direct Debit Authorization

Plan Sponsor- Marion County Medical Society, Inc.- 352-732-8883

Administrative Offices- 352-622-9124, 800-622-9124

104 SE 1st Ave., Suite A, Ocala, FL 34471

P.O. Box 270, Ocala FL 34478