Helpful forms

Choosing your plan (if you’re not a BCBSRI member yet)

The easiest way to enroll in our health and dental plans is using our simple shopping tool online. But we understand that sometimes you need to use paper, so you can download these forms:

2021

  • Enroll in a 2021 medical and/or dental plan
  • Enroll in a 2021 dental direct plan
  • List additional dependents on your application

Making changes (if you already have a BCBSRI plan)

Nota: some changes require a qualifying event before the change can be made.

2021

  • Change your 2021 medical and dental plan
  • Cancel your electronic payments
  • Add Dependent Form (for plans purchased directly from BCBSRI)
    Use this form if you already have a policy with BCBSRI and need to add a new dependent (e.g. newborn, spouse, etc.).

Add other health insurance

Do you or anyone else covered by your Blue Cross health plan have another health plan? If so, we can help you make the most of your benefits—and possibly save you money! Simply complete this form and mail to:

A/C: OCL Department (A) - 00119
Blue Cross & Blue Shield of Rhode Island
500 Exchange Street
Providence, RI 02903-2699

Coupon for expecting Blue Cross Dental members

Studies have shown that it’s important for people who are pregnant to receive regular dental care—that is why pregnant Blue Cross Dental members are eligible for one extra dental cleaning per year with this Dental Coupon.

Other forms you might need

  • International Claim Form
    Claim form used when services are rendered outside of United States. Follow the steps below to access the claim form:
    1. Accept the terms and conditions
    2. Enter the 3 character prefix from the member's ID
    3. Click on Claim Forms and choose the form preferred
    *For more information and to confirm your coverage, please call Customer Service
  • Member Reimbursement Donor Egg and Sperm
    Complete and submit this form to request reimbursement.
  • Member Reimbursement Oral Enteral Food Products Form
    Complete and submit this form to request reimbursement.

Vamos conversar

Participe num evento presencial ou online

Saiba mais sobre os planos deste ano, ouça o que outras pessoas estão a perguntar e obtenha respostas para as suas próprias perguntas. O RSVP é obrigatório.

View events calendar

Agende uma videochamada

Estamos prontos para ajudar. Use o nosso calendário online para escolher um horário conveniente para si.

Agende uma chamada

Contacte-nos

Send our sales team a message

Use o nosso formulário conveniente e responderemos ao seu e-mail em dois dias úteis.

Conte-nos mais

Ligue-nos

Call 1-844-418-2384 to speak with a member of our sales team.

Envie-nos um e-mail

Informe-nos do que precisa e responderemos em dois dias úteis.

Obrigado por nos enviar as suas informações.

We will be in touch soon to help you choose a plan that's right for you.

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