IMPORTANT: By completing this card, you authorize a Florida Blue agent to contact you through February 2024 with information on individual under 65 insurance, HMO coverage and ancillary products (dental, life and disability) we offer. Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., D/B/A Florida Blue. HMO coverage is offered by Health Options Inc. Dental, Life and Disability are offered by Florida Blue Combined Life. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Supplemental, Life, and Disability products are offered by USAble Life. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-855-601-9465 (TTY: 1-877-955-8773). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-855-601-9465 (TTY: 1-800-955-8770). Y0011_33319_C 1118 C: 11/2018

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IMPORTANT: By completing this card, you authorize a Florida Blue agent to contact you through February 2024 with information on individual under 65 insurance, HMO coverage and ancillary products (dental, life and disability) we offer. Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., D/B/A Florida Blue. HMO coverage is offered by Health Options Inc. Dental, Life and Disability are offered by Florida Blue Combined Life. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Supplemental, Life, and Disability products are offered by USAble Life. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-855-601-9465 (TTY: 1-877-955-8773). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-855-601-9465 (TTY: 1-800-955-8770). Y0011_33319_C 1118 C: 11/2018