Authorization

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

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

PDF  Authorization Form - Waive Premium Conversion Plan

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

PDF  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

PDF  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