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Enroll / Elect / Apply Forms

PDF  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

PDF  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

PDF  Enrollment Kit - Dental - Individual (Individuals-Families) | Horizon BCBSNJ

New subscribers should use this form to enroll in the Horizon Individual Dental Plan ID: 9219

PDF  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