Get Individual Agent Of Record Letter - Selecthealth - Selecthealth

Filling out the Individual Agent Of Record Letter for SelectHealth can seem challenging, but this guide will provide you with a clear and structured approach. Follow the steps outlined below to ensure you complete the form accurately and effectively.

Follow the steps to successfully complete the Individual Agent Of Record Letter online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the date at the top of the form in the format of month, day, and year.
3. Input the name and address of the recipient, Mrs. Janica Blackhurst, as follows: SelectHealth, P.O. Box 30192, Salt Lake City, UT 84130-0192.
4. Designate the client by filling in the 'Client Name' section and entering the effective date next to 'effective' in the appropriate format.
5. Specify the 'Agent Name' who will act as Agent of Record in the designated field.
6. Provide information regarding the medical and/or dental insurance product(s) purchased from SelectHealth.
7. Sign the letter where indicated, ensuring your signature is clear and dated. Type or print your name following the signature.
8. Complete the ‘Subscriber ID#’ field with the relevant identification number.
9. The Agent of Record must sign where indicated at the bottom of the letter, including the date of acceptance.
10. After reviewing the completed document for accuracy, save the changes, and choose to download, print, or share the form as needed.

Complete your Agent Of Record Letter online to ensure smooth handling of your insurance needs.