Midsize Group (51-99)
Use this form to enroll a new subscriber, or make a change to a current enrollment, to a Horizon BCBSNJ Medical or Dental plan for mid-size and large groups.
ID: 6859 (11/15)
This is a Spanish version of the form to enroll a new subscriber, or make a change to a current enrollment, to a Horizon BCBSNJ Medical or Dental plan for mid-size and large groups.
ID: 6859 (11/155)
You can customize this Broker-of-Record Letter template with an account company's letterhead and other identifying details.
Horizon HMO, Horizon POS, Horizon Direct Access, Horizon EPO, Horizon PPO, Traditional, National Accounts and OMNIA Health Plan members use this form for medical claims.
ID: 7190 (09/21)
Members can use this fillable agreement authorizing Horizon Blue Cross Blue Shield of New Jersey to debit a checking account.
ID: 8977 (W04/13)
Members can use this fillable form to report deductible credits to carry over, for the current calendar year only.
ID: 7239 (W0616)
This fillable form to request continuance of enrollment for a disabled dependent includes eligibility information.
ID: 9429 (W06/13)
Members can complete this form and present to a physician, medical practice or institution to initiate a release or transfer of medical record information to another physician, medical practice or institution.
ID: 7953 (W06/16)
Use this form to submit checks for Internet Group enrollments.
ID: CM0008179 (06/16)