Small Group
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
Authorization Form - Waive Health Benefits Coverage (Small Groups)
Use this form to waive/decline health benefits coverage. ID: 32286
Small Employer Group Application
Use this form if applying for standard health insurance coverage. ID 32327
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
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
Small Business Health Options Program (SHOP) Application
Use this form if applying for Small Business Health Options Program (SHOP) coverage. ID: 32328
Small Employer Vision Group Application
ID: 32245