getbluema - Blue Cross Blue Shield of Massachusetts

Request a Quote

Every business's needs are unique. That's why we're ready to work with you to get your employees the coverage they deserve.
Complete the form below and an Account Associate will contact you by telephone or email. Of course, you can always call us,
Monday through Friday, 8 a.m. to 5 p.m. EST, at 1-800-422-3545.

* Are you currently working with a broker?
Yes No

* Are you an existing account with Blue Cross Blue Shield of Massachusetts?
Yes No

* First Name:

* Last Name:

* Company Name:

* Address:

Address 2:

* City:

* State * ZIP Code:

* Phone:

Ext: * Email Address:

SIC:

* Type of Industry:

* Total Number of Employees:

* Total Number of Eligible Employees:

Employee	*Type of Coverage	*Date of Birth			* Home ZIP Code
1			/	/
2			/	/
3			/	/
4			/	/
5			/	/
6			/	/
7			/	/
8			/	/
9			/	/

* Are any employees located out of Massachusetts?
Yes No

* What plans are you interested in learning about?
HMO PPO Not Sure

* What products are you interested in learning about?
Medical Dental Life/STD/LTD/AD&D

* How would you prefer to be contacted?
Phone Email

Final rates are subject to SIC code verification, underwriting review and actual enrollment as of the plan effective date.

Eligible Employees—Permanent full-time employees regularly work 30 or more hours per week and permanent part-time employees working at least 20 hours, but less than 30 hours per week, at the employer's usual place of business and paid in accordance with state & federal wage requirements.

Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association.
® Registered Marks of the Blue Cross and Blue Shield Association.
© 2011 Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.
Landmark Center, 401 Park Drive, Boston, MA 02215-3326 | 800-262-BLUE (2583)

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