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Download the COVID-19 Resource Guide (as of March 27, 2023), created especially for our valued customers.

Inquiry / Request

PDF  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

PDF  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

PDF  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

PDF  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

PDF  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