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Addendum C Agent Conditions For Appointment JANUARY 1

Addendum C Agent Conditions For Appointment JANUARY 1 2026

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The document outlines the conditions for appointment of agents with Blue Cross and Blue Shield of Florida (BCBSFL) for the calendar year 2010. It includes detailed application requirements, agent and agency information, licensing criteria, employment history, privacy and security obligations regarding protected health information, and good standing criteria that agents must meet to maintain their appointment. The document emphasizes compliance with state regulations and BCBSFL policies.

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Click ‘Get Form’ to open the Addendum C Agent Conditions For Appointment in the editor.
Begin by filling out the Agency Information section. Ensure that all fields, including Agency Name, Code, Address, and Contact details, are accurately completed.
Proceed to the Agent Information section. Enter your CMS test score, date taken, name, date of birth, SSN, gender, and home address. Make sure this information matches your official records.
In the Correspondence Address section, provide your contact details for communication purposes. This includes your email address which is essential for system access.
Answer the eligibility questions regarding residency and licensing status in Florida. If applicable, include license numbers and types in the designated fields.
Complete the Employment History and References sections by providing accurate details about your current and previous employment along with references.
Review all entries for accuracy before printing out the application. Sign and date where indicated before submission.

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