Individual & Family Forms
Use this form to set up your employer group's account for ACS/Mellon Health Savings Accounts.
Use this form to confirm your employer group's selection of a Horizon Blue Cross Blue Shield of New Jersey MyWay Health Savings Account for tax-free saving and health care spending. ID: HOR5890
Use this form to enroll a new subscriber to a Horizon BCBSNJ Medical plan for small groups. ID: 845
ID: 744 With Peds (W1017)
ID: 744 con peds (W1017)
New Jersey law required that contract holders that apply for or renew a high deductible health plan which qualified medical expenses are paid using a health savings account receive a "Declaration of Understanding" that describes certain features of the plan.