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Broker's Guide

How to Enroll Health and Dental

BCBSRI - Group size 1-50 (eligible employees)
Submit to General Agent:

• Completed and signed Sales Agreement
• First month's premium (payable to BCBSRI)
• Completed BCBSRI enrollment applications (must include social security number)
• Completed waiver forms (if applicable)

BCBSRI - Group Size 51+ (eligible employees)
Submit to your BCBSRI Representative:

• Completed and signed Sales Agreement
• First month's premium (payable to BCBSRI)
• Completed enrollment applications
• Waiver cards
• Certification of employer size (if required)
• Signed broker commission authorization form (if required)

Blue Cross Dental*
Group Size 3-50 (eligible employees), submit to General Agent
Group Size 51+ (eligible employees), submit to your BCBSRI Representative

• Completed and signed Sales Agreement
• First month's premium (payable to BCBSRI)
• Completed dental enrollment applications if enrolling for dental only
• Proof of eligibility

*Applications are not needed if enrollee is already a BCBSRI member.