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.

 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 32287

 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

 Enrollment Form - Dental (Small Groups)

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

 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