Required fields have a * next to them. These fields MUST be completely filled out.

*Name:
*Date of Birth:
Spouse's D.o.B.:
No. of Children:	(Ex. F6 for Female 6yrs old, M10 for Male 10yrs old. Seperate multiple children with commas)
*Address:
City:
State:	Please Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
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Best time to call:	Select Morning Afternoon Evening
*E-mail Address:
Type of coverage desired:	(Such as Medical, Medicare, Dental, Life, etc..).

At 1st Miami Associates we’re interested in helping you stay healthy. As a contracted Blue Cross Blue Shield of Florida agency we offer Floridians personalized health solutions with flexible options designed to meet your needs. You have a choice of a wide range of comprehensive health care solutions, from conventional plans, HSA - compatible high-deductible plans, lower cost and limited benefit plans and much more. Many plans have optional maternity benefits as well and Child Only coverage is available for dependent children ages one to 17. Whether you’re interested in permanent or temporary coverage just fill out the quote request and we’ll promptly get back to you.