Helpful Forms

Choosing Your Plan (if you’re not a BCBSRI member yet)

The easiest way to enroll in our health and dental plans is using our simple shopping tool online. But we understand that sometimes you need to use paper, so you can download these forms:

Enrollment Forms

Making Changes

Dependent Addendum for 2017 Plans for Individuals and Families
If the Health and Dental application for individuals and families does not accommodate all of your dependents, please use this 2017 form in addition to the application.

Free coupon for expecting BCBSRI Dental members.
Studies have shown that it’s important for pregnant women to receive regular dental care—that is why pregnant Blue Cross Dental members are eligible for one extra dental cleaning per year by clicking on the link below.