Florida Individual

Florida Individual & Group Health Insurance
Applications, Description & Forms

All of the applications and descriptions have been converted to PDF files. To view these forms, you will need Adobe Acrobat Reader which is a FREE Download.
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Plan descriptions and applications can be found here and downloaded. All applications need to be fully completed and signed to be processed. If you are self-employed or a business you will need to provide at least 2 proofs of business. One of those must be business taxes. For self-employed persons that must include a schedule C and for larger business must include a UCT6. Corporate paperwork or an occupational license alone is not sufficient.

Generally required for Business health insurance:

Employer application
Employee applications, including waivers for employees declining coverage
Check for first month's premium made payable to insurance company
Federal Tax Form 941 and particularly the UCT6
Business or occupational license
Quarterly wage and tax statements for past 2 quarters
If self-employed 1040 Schedule C

Individual Health Insurance applications require completion of the application and a check made payable to the insurance company or HMO. The check can be for one month, quarterly, semi-annually or annually. Premiums must be paid with a personal check from the insured. American Medical Securities will charge an additional $10 for each time a bill is sent if you would rather be direct billed instead of setup as a bankdraft.

We look forward to hearing from you and receiving your paperwork. If you would like an e-mail confirmation sent to you that we have received your paperwork, please let us know, being sure to include your e-mail address.

All Paperwork is to be returned to

Pierre Grangr AAI,CIRMS
8181 NW 154th Street # 230
Miami Lakes, FL 33180

Applications and Plan Descriptions

American Medical Security/United Wisconsin Life Insurance Company

Blue Cross Blue Shield

Census Form

Conseco (no longer offered in Florida)

DentiCare