P1-1key-Referral Indemnity EN – Agent

Referral Indemnity Agent

Steps to follow:

1-INFORM THE MEMBER THAT SONIA BEATO, OF 1 KEY INSURANCE SOLUTIONS, INC. IS THEIR FLORIDA BLUE INSURANCE BROKER.

2-SOLITE THE MEMBER TO SIGN THE AUTHORIZATION FORM FOR SONIA BEATO OF 1 KEY INSURANCE SOLUTIONS, INC. TO PROCESS AND ENTER THE APPLICATION FOR DENTAL OR INDEMNITY INSURANCE (MUST INFORM THE MEMBER THAT THE PREMIUM PAYMENT FOR THE DENTAL APPLICATION WILL BE MADE BY FLORIDA COMBINED LIFE, A SUBSIDIARY OF FLORIDA BLUE).

3-SOLITE THE MEMBER TO SIGN THE AUTHORIZATION FORM FOR SONIA BEATO OF 1 KEY INSURANCE SOLUTIONS, INC. TO PROCESS AND ENTER THE APPLICATION FOR DENTAL, HOSPITAL INDEMNITY OR CRITICAL ILLNESS. (MUST ADVISE THE MEMBER THAT PREMIUM PAYMENT WILL BE CHARGED BY USABLE LIFE, A SUBSIDIARY OF FLORIDA BLUE).

4-MUST SUBMIT THE APPLICATION WITH THE FIRST PAYMENT. YOU MAY USE EITHER A CREDIT/DEBIT CARD OR A BANK ACCOUNT.
AUTOMATIC PAYMENT IS RECOMMENDED.

Policy holder name:

Effective date:

Date of birth:

Email:

Last 4 digits of SSN:

Address:

APT #:

ZIP Code:

Phone number:

Select a Plan

DENTAL

FLORIDA COMBINES LIFE FOR DENTAL TOTAL

ACCIDENT

UsABLE FOR ACCIDENT TOTAL

HOSPITAL

UsABLE FOR HOSPITAL PLAN TOTAL

CRITICAL CARE

UsABLE FOR CRITICAL CARE PLAN TOTAL

Bank Information

Routing number:

Bank account only:

Automatic Payment:

Debit/Credit card info
First payment only

Cardholder name:

Billing Address:

Credit Card number:

Type:

Card:

Expiration Month:

Expriration Year:

Security code:

Name of the Agent:

Phone number:

Email:

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