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Update Your Broker Information

If you're a broker, you can request a change of address, phone, e-mail, or fax number by supplying the following information in the form below. Or print and fax this form to (423)535-3178.

* Required fields

What information is changing?^*

Address

Phone

Other

First Name^*

Last Name^*

Agency Name

Agency ID #

New Address

Street^*

City^*

State^*

Zip^*

Phone^*

Fax

Email^*

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©1998-2021 BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 1 Cameron Hill Circle, Chattanooga, TN 37402-0001