Small Group Forms
Use this form to waive/decline health benefits coverage. ID: 32286
This form is to certify that small group employer criteria is met. ID: 32285
Use this form to enroll a new subscriber, or make a change to a current enrollment, to a Horizon BCBSNJ Medical, Dental, or Vision plan for small groups. ID: 6803
Fax cover sheet for the Internet Group Enrollment (North) process related to medical plans. ID: 7210
Use this form if applying for a Health Plus Plan.
Use this form if applying for standard health insurance coverage along with a Health Plus Plan.
Members with a mentally-impaired or physically-disabled child can use this form to request that the child be covered by the parent’s medical plan. ID: 2407
Use this form if applying for Small Business Health Options Program (SHOP) coverage. ID: 32328
Use this form if applying for standard health insurance coverage. ID: 32327
Application For a Small Group Horizon Level Select Health Benefits Policy (15 to 50 eligible employees)