Health/ Dental Benefits and Life Insurance

Health & Dental Benefits

Blue Cross Blue Shield of RI

Original Plans

  1. Blue Cross Blue Shield (BCBS) Application (PDF)
  2. Blue Cross Blue Shield (BCBS) Classic Benefit Summary - Certified And Non-Certified (PDF)
  3. Delta Dental Application or Enrollment Form (PDF)
  4. Dental Benefits (PDF)
  5. Health Mate Coast-to-Coast (HMCC) Medical Benefit Summary- Certified And Non Certified (PDF)
  6. Health Mate Coast-to-Coast (HMCC) Medical Benefit Summary- Custodians (PDF)

January 1, 2018

To access the HSA portal, please login through your Blue Cross account and click on YOUR HSA through the GRAY TAB and not through the new portal.

BCBSRI High Deductible Health Plan and Coinsurance Plan

HSA - High Deductible Health Plan

Coinsurance PPO Plan (you need to qualify for this plan

Important Information

Contribution and Rate information

Blue Cross Blue Shield Q& A

HSAs - IRS, ACA and Medicare

Life Insurance

Life Insurance Application

Security Mutual Life Insurance - Certificate of Insurance

Change of Beneficiary Form

Forms can be completed and sent to Rose Emilio at Central Office:

111 Pierce Street

East Greenwich, RI 02818

*If you have any questions, please feel free to call Rose at 401-398-1222 or email .

If you currently have medical and dental and would like to change to Buyback you must send in a formal request to cancel your medical and dental. Please do not just fill out the buyback form. Send cancellation requests to the provided email.

Quick Links

  1. BuyBack 2017 - 2018 (Do not fill out if you currently have medical)
  2. Blue Cross Blue Shield of Rhode Island
  3. Delta Dental of Rhode Island