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Download the COVID-19 (Coronavirus) Resource Guide (as of May 15, 2020), created especially for our valued customers.

Small Group

PDF  New Jersey Small Employer Certification

Annual certification is required by the New Jersey Small Employer Health Benefits Plan Act (N.J.S.A. 17B:27A-17 et seq.) Failure to comply may result in discontinuance of your group’s Horizon BCBSNJ health benefits plan. ID: 32285

PDF  Authorization Form - Waive Health Benefits Coverage (Small Groups)

Use this form to waive/decline health benefits coverage. ID: 32286

PDF  Small Employer Group Application

Use this form if applying for standard health insurance coverage. ID 32327

PDF  Enrollment Change/Request form Medical/Dental/Vision (Small Groups)

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

PDF  Enrollment Form - Dental (Small Groups)

Use this form to enroll a new subscriber to a Horizon BCBSNJ Dental plan for small groups. ID: 7546

PDF  Request Form - Medical - Continuance of Enrollment for Disabled Dependent (Groups 2-50)

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

PDF  Small Business Health Options Program (SHOP) Application

Use this form if applying for Small Business Health Options Program (SHOP) coverage. ID: 32328