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 Operations via email or mail:
Blue Cross & Blue Shield of Rhode Island
Attn: Broker Operations Department
500 Exchange Street
Providence, RI 02903
If you have any questions, please call Broker Operations at (401) 459-5545, option 2.