Sweeps - Data Capture

First Name*

Last Name*

Zip Code*

State

Are you eligible or enrolled in Medicare?*

Yes

Are you a member?*

Yes

Do you consent to be contacted by a Florida Blue Sales Agent to discuss insurance plans?

Phone Number

By checking the box below and clicking the Submit button, you confirm that you are the subscriber or authorized user of the phone number provided above, and you consent to receive calls and text messages at that number from, and on behalf of, the companies selected below and their appointed and licensed insurance agents, including calls and texts using an automated telephone dialing system, prerecorded or artificial voice messages, or both. The types of calls and texts you consent to receive include messages that market, offer, or promote the purchase of health and supplemental insurance plans, products, and services. Your consent is not required as a condition of any renewal or purchase and you may revoke your consent at any time. Message and data rates may apply. Message frequency varies. Major carriers supported.

Health insurance PPO and HMO plans offered by Florida Blue and Florida Blue HMO, Dental plans offered by their affiliate, Florida Combined Life Insurance Company, Supplemental accident and illness plans offered by USAble Life, Travel health insurance offered by GeoBlue.

By clicking this checkbox, you agree to the rules of this enter-to-win sweepstakes.

Email Address*

By providing your email address, you consent to receive email marketing communications, including from a licensed insurance agent.

You also acknowledge and agree to be bound by our Terms of Use and Privacy Policy which are available online at floridablue.com.

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., Florida Blue HMO is a trade name of Health Options, Inc., Florida Combined Life Insurance Company is a trade name of Florida Combined Life Insurance Company, Inc., and GeoBlue is a trade name of Worldwide Insurance Services, LLC (Worldwide Services Insurance Agency, LLC in California and New York) and the administrator of coverage provided under insurance policies issued by 4 Ever Life International Limited, Bermuda. All companies are independent licensees of the Blue Cross and Blue Shield Association.

USAble Life is an independent company and operates separately from Florida Blue and its affiliates.

Sorry!