Enroll / Elect / Apply

 Election Form - Spending-Savings Accounts - Flexible Spending Account

Use this form to enroll in an Unreimbursed Medical or Dependent Care Flexible Spending Account. ID: 8997

 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

 Enrollment/Change Request Form - Dental (NJ)

Use this form to enroll new members or to make a change to an existing enrollment in a Horizon BCBSNJ dental plan. ID: 2149

 Enrollment/Change Request Form - Medical and Dental (Mid-Size and Large Groups)

Use this form to enroll a new subscriber, or make a change to a current enrollment, to a Horizon BCBSNJ Medical or Dental plan for mid-size and large groups. ID: 6859

 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