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Group Health - BC/BS of RI

Membership Applications:        · Group Member Application        · Group Dependent Addendum        · Group Plan65 Member Application        · BlueCHiP for Healthy Options Member Application

Employee Risk Appraisal        · Download Form

Affidavit for Owner / Employee Not on Payroll

Waiver of Coverage        · Download Form

Authorization Agreement For Direct Payments        · Download Form

New Business Underwriting Checklist

Request for Group Insurance Amendment To Sales Agreement

Group Health - United HealthCare

Membership Application / Change Form

Health Screening Questionnaire

Small Group Application

Employer Participation Agreement

Benefit Options Checklist

Authorization Agreement For Direct Payments

Retiree Medical

Employee Form for Enrollment        · Download Form

Employer Form for Enrollment

RX Direct Reimbursement Claim Form

Authorization Agreement For Direct Payments        · Download Form

Group Dental Insurance

Group Application        · Download Form

Enrollment Form        · Download Form

Authorization Agreement For Direct Payments        · Download Form