Plan65

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

Medical Underwriting Questionnaire
The Medical Underwriting Questionnaire is only needed if you don’t meet general eligibility requirements.
(PDF 651KB)

Last updated: 02/13/2015

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.