INDIVIDUAL AGENT OF RECORD LETTER
Janica Blackhurst
SelectHealth
P. O. Box 30192
Salt Lake City, UT 84130-0192
Dear Ms. Blackhurst:
I hereby designate Lloyd Coleman as Agent of Record, effective the date signed below with respect to the medical and/or dental insurance product(s) purchased from SelectHealth.
In making this designation, I authorize my Agent of Record to access information about my insurance products and represent me to facilitate the ongoing service of my product(s).
I understand that adding or changing the Agent of Record does not change the premium of my product(s) and is included as part of my policy at no additional cost. Any compensation from SelectHealth payable to an agent should be directed to:
Lloyd Coleman / Clarity Insurance Advisors
801-432-5000
8899 S 700 E, Suite 155
Sandy, UT 84070
This Agent of Record Letter rescinds any prior appointments of agent/agency with respect to this coverage and shall remain in effect until revoked or replaced in writing. I understand SelectHealth will notify the current agent of this change.
I understand that the terms and condition's of this appointment will be subject to SelectHealth’s specific contractual requirements, as well as your normal agent appointment procedures.
I understand that SelectHealth may contact me to validate the authenticity of this letter. I have provided my phone number and email.
