Small Employer Common Ownership Certification

June 21, 2018

Applies to: Small Group market

Horizon Blue Cross Blue Shield of New Jersey has introduced a Small Employer Common Ownership Certification form. Horizon BCBSNJ offers this form as a convenient way for small employers (one to 50 employees) to declare affiliated companies, subsidiaries or common ownership per section 414 of the InternalRevenue Code of 1986.

The employer’s accountant or attorney should complete and submit this form, rather than sending an “Affiliation Letter” as had previously been required. Prior to being submitted, the form should be signed by the employer’s accountant or attorney and by an officer, partner or proprietor of the employer.

The form can be downloaded from the Small Group Forms menu at HorizonBlue.com/brokers.

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