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New Broker of Record Form

January 25, 2018
Applies to: Individual market

Horizon Blue Cross Blue Shield of New Jersey recently revised the form used by consumers in the Individual market to declare their broker of record to Horizon BCBSNJ. The new form is in full compliance with the Centers for Medicare & Medicaid Services (CMS) standards for agents and brokers to obtain proof of consent prior to assisting consumers with health plan purchases on and off the Health Insurance Marketplace.

The new Broker of Record form should be used for health plan purchases both on and off the Health Insurance Marketplace. Horizon BCBSNJ’s previous version of the Broker of Record form will continue to be accepted until further notice; however, you are encouraged to begin using the new form immediately.

The new form is attached, and can also be downloaded from the Forms by Type section.

If you have questions, please contact your Horizon BCBSNJ sales executive or account manager.

View PDF version

Published on: January 29, 2018, 07:32 a.m. ET
Last updated on: June 28, 2021, 03:41 a.m. ET