Census Form
(print, fill out, and fax to 401-828-7802)
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- Membership Application
(print, fill out, and fax to 401-828-7802)- Waiver of Coverage
(print, fill out, and fax to 401-828-7802)- Group Risk Appraisal Form
(print, fill out, and fax to 401-828-7802)- Employee Risk Appraisal Form
(print, fill out, and MAIL to: The Good Neighbor Alliance Corporation, P.O. Box 1421, Coventry, RI 02816)
- Supplemental Application for Dependent Student Coverage
(print, fill out, and fax to 401-828-7802)- Group Activity Report- additions, cancellations and changes
- (print, fill out, and fax to 401-828-7802)
- Blue Cross Renewal Certification (print, fill out, and fax to 401-828-7802)
- Blue Cross Appendix One- Definitions (print, fill out, and fax to 401-828-7802)
- Blue Cross Amendment to Sales Agreement (print, fill out, and fax to 401-828-7802)-
- Group Activity Report- additions, cancellations and changes