Authorization

 Authorization Form - Waive Health Benefits Coverage (Small Groups)

Use this form to waive/decline health benefits coverage. ID: 2465

 Authorization Form - Waive Premium Conversion Plan

Use this form to waive/decline participation in the Premium Conversion Plan. ID: 16117

 Automatic Pay Plan Form (Groups)

Use this form to authorize Horizon BCBSNJ to debit the checking account of a group on a regular monthly basis. ID: 8977

 Automatic Pay Plan Form (Individuals and Families)

Use this form to authorize Horizon BCBSNJ to debit the checking account of an individual on a regular monthly basis. ID: 2782