Blue Cross Blue Shield Major Medical Florida

Using claims data from health, drug and other relevant information, the Personal Health Record offers members a personalized Health Action Plan that provides specific action items for health improvements, links to programs to manage possible health issues and detailed information about health conditions to ensure that members are fully educated about their health and have options to make improvements. Members who are identified with diabetes, asthma, coronary artery disease or one of more than 30 other health topics will get access to a condition manager that provides specific programs, tools and information to take the necessary health actions and better understand their conditions.

The Personal Health Record also allows members to easily enter information about their own health history in order to track all aspects of their personal health information in one centralized and secure system. Record-keeping functionality includes medication tracking, immunizations,

Primary Applicant Information:
Gender	Birthdate	Height	Weight	Tobacco?

Spouse Information:
Gender	Birthdate	Height	Weight	Tobacco?

	Gender	Birthdate	Height	Weight
Child 1 Information:

Is anyone to be included in this quote pregnant? *	Yes No
Does anyone to be included currently have health insurance? *	Yes No

If any person applying has any of the following conditions, please check the corresponding box:
AIDS / HIV	Alcohol / Drug Abuse	Alzheimer's / Dementia
Asthma	Cancer	Clinical Depression
Diabetes	Emphysema	Epilepsy
Heart Attack	Heart Disease	Hepatitis / Liver
High Blood Pressure	High Cholesterol	Kidney Disease
Mental Illness	Multiple Sclerosis	Pulmonary Disease
Stroke	Ulcers	Vascular Disease
Other / Not Listed	If other, please list conditions:

Blue Cross Blue Shield Major Medical Florida

Fast and Free Health Insurance Quotes

Pay less for your Health Insurance. Complete the following short form.

Primary Applicant's Occupation: (If full-time student, write "student")
Is the primary applicant currently self employed? *	Yes No


First Name *		Last Name *
Address *		City *
State *		Zip Code *
Day Phone *		Evening Phone
Email *