Follow the steps to complete your application with ease.

1. Press the ‘Get Form’ button to access the form and open it for your completion.
2. Begin with section 1, 'Employer Information.' Here, the plan administrator must fill in the group name, effective date, group number, and department number. Select the applicable option for enrollment type: Open enrollment, New hire, COBRA, Loss of coverage, or Other.
3. Move to section 2, 'Employee Information.' Enter the employee's last name, first name, middle initial, home address, mailing address, city, state, and ZIP code. Provide the date of hire and the employee's date of birth. Include the home phone number, gender, marital status, primary language spoken, race, and email address.
4. In section 3, 'Health Plan Options,' choose the type of coverage: Dental, Medical, or Vision, and specify if it is for an individual or family. Select the desired product from the provided options and fill in the metallic level, coinsurance, and deductible details.
5. Section 4 focuses on 'Spouse or Domestic Partner Information.' Provide their last name, first name, date of birth, home address, and contact information. Indicate if they are a current patient of the selected primary care physician.
6. Next, complete section 5 for each dependent. Include details such as name, relationship, date of birth, and primary care physician. Specify the type of coverage applied for and indicate their current patient status.
7. In section 6, answer whether you or any dependents have other insurance. If yes, include the insurance company's name and member ID number. Provide the name of previous medical coverage and its end date and indicate if anyone is eligible for Medicare.
8. Finally, in section 7, sign and date the application, certifying that all information is accurate. Review the entire form for completeness before submission.
9. Once completed, users can save changes, download, print, or share the form as necessary.

Complete your RI BCBS Group APP online today for prompt processing.