Become a BCBSRI Broker

Thanks for your interest in offering BCBSRI plans to your clients. In order to be appointed as a broker with BCBSRI, please submit the following forms. Use this checklist to help you.

Broker Application
Broker Agreement
Broker Confidentiality Agreement
Electronic Remittance Advice Plan Instructions and Electronic Funds Transfer (EFT) Authorization Form
W-9 Form
Broker of Record Form*

*Please note that the Broker of Record Form for a new client is now required in order to be appointed as a broker for BCBSRI.

Submit all forms to Broker Relations via email or mail:

BrokerRelations@bcbsri.org

Blue Cross & Blue Shield of Rhode Island
Attn: Broker Relations Department
500 Exchange Street
Providence, RI 02903

If you have any questions, please call Broker Relations at (401) 459-5545, option 2.