Small Business Quote Form

Every business is 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 Executive will contact you by telephone or email. Of course, you can always call us,
Monday through Friday, 8:30 a.m. to 4:30 p.m. EST, at 1-800-422-3545.

Are you currently working with a broker? *This question is required.

This form is intended for non-brokered new business quotes only. If you are currently working with a broker, please contact them directly for assistance in obtaining a new business quote from Blue Cross Blue Shield of Massachusetts.

Does your company currently offer Blue Cross Blue Shield of Massachusetts insurance? *This question is required.

This form is intended for new business quotes only. If you are an existing Blue Cross Blue Shield of Massachusetts group account, please contact your Account Executive directly.

When would you like coverage to be effective?

Within the next: *This question is required.

First Name: *This question is required.

Last Name: *This question is required.

Company Name: *This question is required.

Address: *This question is required.

Address 2:

City: *This question is required.

State: *This question is required.

Blue Cross Blue Shield of Massachusetts group coverage can only be provided to companies whose headquarters is in MA.

ZIP code: *This question is required.

Phone: *This question is required.

Ext:

Email Address: *This question is required. This question requires a valid email address.

SIC (Standard Industrial Classification):

Type of Industry: *This question is required.

Are any employees located outside of Massachusetts? *This question is required.

What plans are you interested in learning about? *This question is required.

HMO
PPO
EPO
Not Sure

What products are you interested in learning about? *This question is required.

Medical
Dental
Vision

How would you prefer to be contacted? *This question is required.

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. ®´ Registered Marks of Blue Cross and Blue Shield of Massachusetts, Inc., and Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. ®´´ Registered Marks, TM Trademarks, and SM Service Marks are the property of their respective owners. © 2024 Blue Cross and Blue Shield of Massachusetts, Inc., or Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc.

Small Business Quote Form

Request a Quote