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.

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