Inquiry / Request
Request Form - Dental - Credit for Deductible Carryover
If new members (and/or covered family members) have met all or part of their deductible under a prior dental plan, use this form to request that a credit be applied to their new plan. ID: 7263
Request Form - Dental - Recruit Provider
Give this form to a dentist to invite him/her to join one or more Horizon BCBSNJ dental networks. ID: 9652
Request Form - Medical - Credit for Deductible Carryover
If new members (and/or covered family members) have met all or part of their deductible under a prior Medical plan, use this form to request that a credit be applied to their new plan. ID: 7239
Request for 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 continues to be covered by the parent’s dental plan. ID: 2407
Request for Continuance of Enrollment for Disabled Dependent (Groups 51 Plus)
Members with a mentally-impaired or physically-disabled child can use this form to request that the child continues to be covered by the parent’s dental plan. ID: 9429