BlueCHiP for Medicare

Click on the links below to download forms you may need.

Medicare Part D Vaccine and Administration Claim Form - Coming Soon

Rhode Island Rights of the Terminally Ill Act Declaration (living will)

Privacy Practices
(PDF 41KB)

Last updated: 04/17/2014

H4152_2014website697 Approved

Blue Cross & Blue Shield of Rhode Island is an HMO plan with a Medicare contract. Enrollment in Blue Cross & Blue Shield of Rhode Island depends on contract renewal.