Enroll / Elect / Apply Forms
Dental and Vision Non-Group Enrollment/Change Request - English - 2019
Use this form to enroll a new subscriber to a Horizon BCBSNJ Medical plan for small groups. ID: 845
Enrollment Kit - Dental - Individual (Individuals-Families) | Horizon BCBSNJ
New subscribers should use this form to enroll in the Horizon Individual Dental Plan ID: 9219
Enrollment/Change Request Form – English (Individuals-Families) - 2023
ID: 744 With Peds (W0123)
Enrollment/Change Request Form – Spanish (Individuals-Families) - 2023
744 con Pediátrico (W0123)