Skip to main content
notification

Magellan Health Security Incident

On April 11, 2020 Magellan discovered that they were the target of a ransomware attack.

Notification_close
‌
ALL
searchbutton
  • Home
  • Members
  • Providers
  • Brokers
  • Employers
  • alert
  • Contact Us
  • About Us
  • CAREERS
  • search_has_popup
Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey
READ FAQS MEMBER SIGN IN
Alert
Toggle menu
  • BACKback to www.horizonblue.com
  • MEMBERS
  • Plans and ServicesPlans and Services
    • Plans and Services
    • Away From Home Care ProgramAway From Home Care Program
    • Horizon Blue AppHorizon Blue App
    • Medical PlansMedical Plans
      • Medical Plans
      • BlueCard PPOBlueCard PPO
      • EPO (Exclusive Provider Organization)EPO (Exclusive Provider Organization)
      • Horizon Direct AccessHorizon Direct Access
      • Horizon HMOHorizon HMO
      • Horizon MyWayHorizon MyWay
        • Horizon MyWay
        • About Horizon MyWayAbout Horizon MyWay
        • Horizon MyWay HSAHorizon MyWay HSA
        • Horizon MyWay FSAHorizon MyWay FSA
        • Horizon MyWay HRAHorizon MyWay HRA
        • FIND A DOCTOR
        • MEMBER SIGN IN
        • SHOP FOR A PLAN
      • Horizon POS (Point of Service)Horizon POS (Point of Service)
      • OMNIA Health PlansOMNIA Health Plans
      • Traditional IndemnityTraditional Indemnity
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Horizon DentalHorizon Dental
    • Horizon VisionHorizon Vision
    • Horizon PharmacyHorizon Pharmacy
      • Horizon Pharmacy
      • Flu Shots and Other ImmunizationsFlu Shots and Other Immunizations
      • Generic DrugsGeneric Drugs
      • Orally Administered Cancer Medication Coverage LawOrally Administered Cancer Medication Coverage Law
        • Orally Administered Cancer Medication Coverage Law
        • Orally Administered Cancer Medication Coverage Law FAQsOrally Administered Cancer Medication Coverage Law FAQs
        • FIND A DOCTOR
        • MEMBER SIGN IN
        • SHOP FOR A PLAN
      • Home Delivery Pharmacy ServiceHome Delivery Pharmacy Service
      • Prescription Drug ListsPrescription Drug Lists
        • Prescription Drug Lists
        • Classic Drug List for the ExchangeClassic Drug List for the Exchange
        • Classic Drug ListClassic Drug List
        • Fertility Drug ListFertility Drug List
        • Office-Administered Specialty Medications ListOffice-Administered Specialty Medications List
        • Orally Administered Cancer MedicationsOrally Administered Cancer Medications
        • PA Medical Necessity Drug ListPA Medical Necessity Drug List
        • Patient Protection and Affordable Care Act Preventive Drug ListPatient Protection and Affordable Care Act Preventive Drug List
        • Self-Administered Specialty Medicine ListSelf-Administered Specialty Medicine List
        • NetResults Drug ListNetResults Drug List
        • FIND A DOCTOR
        • MEMBER SIGN IN
        • SHOP FOR A PLAN
      • Specialty RxSpecialty Rx
        • Specialty Rx
        • Specialty Pharmaceutical Pharmacy BenefitSpecialty Pharmaceutical Pharmacy Benefit
        • Specialty Pharmaceutical for Office AdministrationSpecialty Pharmaceutical for Office Administration
        • Specialty Rx Program for Infertility TreatmentSpecialty Rx Program for Infertility Treatment
        • FIND A DOCTOR
        • MEMBER SIGN IN
        • SHOP FOR A PLAN
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Patient-Centered ProgramsPatient-Centered Programs
      • Patient-Centered Programs
      • Accountable Care OrganizationAccountable Care Organization
      • Episodes of CareEpisodes of Care
      • Patient-Centered Medical HomePatient-Centered Medical Home
      • Patient-Centered Pediatric ProgramPatient-Centered Pediatric Program
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • MedicareMedicare
      • Medicare
      • Horizon Healthy JourneyHorizon Healthy Journey
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • MedicaidMedicaid
    • 24/7 Nurse Line24/7 Nurse Line
    • AbleTo Support ProgramAbleTo Support Program
    • Case ManagementCase Management
      • Case Management
      • Specialty Case Management ProgramsSpecialty Case Management Programs
      • Case Management FAQsCase Management FAQs
      • Enrollment FormEnrollment Form
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Chronic Care ProgramChronic Care Program
      • Chronic Care Program
      • Enrollment FormEnrollment Form
      • Program DetailsProgram Details
      • Chronic Care FAQsChronic Care FAQs
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Personal Health AssistantPersonal Health Assistant
    • Horizon CareOnlineHorizon CareOnline
    • Horizon Behavioral HealthHorizon Behavioral Health
    • Horizon Supportive Care ProgramHorizon Supportive Care Program
    • Coverage Outside New JerseyCoverage Outside New Jersey
      • Coverage Outside New Jersey
      • Away from Home Care ProgramAway from Home Care Program
      • BlueCardBlueCard
      • International TravelInternational Travel
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Identity Protection ServicesIdentity Protection Services
    • SHBP and SEHBP MembersSHBP and SEHBP Members
    • Horizon MyWayHorizon MyWay
    • Cancer ProgramCancer Program
    • Pet InsurancePet Insurance
    • Remote Patient Monitoring for COPDRemote Patient Monitoring for COPD
    • FIND A DOCTOR
    • MEMBER SIGN IN
    • SHOP FOR A PLAN
  • Our NetworksOur Networks
    • Our Networks
    • ProvidersProviders
    • Care FacilitiesCare Facilities
    • Urgent Care CentersUrgent Care Centers
    • Sanitas Medical CentersSanitas Medical Centers
    • Clinical Laboratory ServicesClinical Laboratory Services
    • PharmaciesPharmacies
    • Horizon Care at HomeHorizon Care at Home
    • Radiology/Cardiology ImagingRadiology/Cardiology Imaging
    • FIND A DOCTOR
    • MEMBER SIGN IN
    • SHOP FOR A PLAN
  • ToolsTools
    • Tools
    • Connect With Us OnlineConnect With Us Online
    • Our secure member websiteOur secure member website
    • Doctor and Hospital FinderDoctor and Hospital Finder
    • Treatment Cost EstimatorTreatment Cost Estimator
    • Horizon MyWayHorizon MyWay
      • Horizon MyWay
      • Horizon <i>MyWay</i> CDH VideoHorizon <i>MyWay</i> CDH Video
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • The Power of PaperlessThe Power of Paperless
    • Horizon Blue AppHorizon Blue App
    • FIND A DOCTOR
    • MEMBER SIGN IN
    • SHOP FOR A PLAN
  • FormsForms
    • Forms
    • Search by Form TypeSearch by Form Type
      • Search by Form Type
      • Appeal / Dispute FormsAppeal / Dispute Forms
      • Authorization FormsAuthorization Forms
      • Claim FormsClaim Forms
      • Enroll / Elect / Apply FormsEnroll / Elect / Apply Forms
      • Inquiry / Request FormsInquiry / Request Forms
      • Manage Private Information FormsManage Private Information Forms
      • Prescription Drug Mail Order FormsPrescription Drug Mail Order Forms
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Search by Frequently Used FormsSearch by Frequently Used Forms
      • Search by Frequently Used Forms
      • Dental FormsDental Forms
      • Manage Private Information FormsManage Private Information Forms
        • Manage Private Information Forms
        • Authorization for Disclosure OR Request For Access to Protected Health InformationAuthorization for Disclosure OR Request For Access to Protected Health Information
        • HIPAA - Request to Represent a Deceased MemberHIPAA - Request to Represent a Deceased Member
        • HIPAA - Request to Terminate Personal RepresentativeHIPAA - Request to Terminate Personal Representative
        • HIPAA Request for Appointment of Personal RepresentativeHIPAA Request for Appointment of Personal Representative
        • Request for Accounting of DisclosuresRequest for Accounting of Disclosures
        • Request for Amendment of Private InformationRequest for Amendment of Private Information
        • FIND A DOCTOR
        • MEMBER SIGN IN
        • SHOP FOR A PLAN
      • Medical FormsMedical Forms
      • Prescription FormsPrescription Forms
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Search by Plan TypeSearch by Plan Type
      • Search by Plan Type
      • Away from Home Care FormsAway from Home Care Forms
      • Dental FormsDental Forms
      • Horizon NJ TotalCare (HMO D-SNP) FormsHorizon NJ TotalCare (HMO D-SNP) Forms
      • Medical FormsMedical Forms
      • Pharmacy FormsPharmacy Forms
      • Spending / Savings Account FormsSpending / Savings Account Forms
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • FIND A DOCTOR
    • MEMBER SIGN IN
    • SHOP FOR A PLAN
  • WellnessWellness
    • Wellness
    • My Health ManagerMy Health Manager
      • My Health Manager
      • Get the Facts on FiberGet the Facts on Fiber
      • Health AssessmentHealth Assessment
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Living and SavingsLiving and Savings
      • Living and Savings
      • HorizonbFitHorizonbFit
      • Healthy DiscountsHealthy Discounts
      • Horizon Balance LivingHorizon Balance Living
        • Horizon Balance Living
        • Balance Living FAQsBalance Living FAQs
        • FIND A DOCTOR
        • MEMBER SIGN IN
        • SHOP FOR A PLAN
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Maternity ProgramMaternity Program
      • Maternity Program
      • Maternity Health CoachMaternity Health Coach
      • My Pregnancy AssistantMy Pregnancy Assistant
      • Postpartum DepressionPostpartum Depression
      • Is Breastfeeding Right for You and Your Baby?Is Breastfeeding Right for You and Your Baby?
      • Enrollment FormEnrollment Form
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • FIND A DOCTOR
    • MEMBER SIGN IN
    • SHOP FOR A PLAN
  • Education CenterEducation Center
    • Education Center
    • Advance DirectiveAdvance Directive
    • Coverage decisionsCoverage decisions
    • Gaining a better understanding of ProstheticsGaining a better understanding of Prosthetics
    • Making a PaymentMaking a Payment
      • Making a Payment
      • Protect Your CoverageProtect Your Coverage
        • Protect Your Coverage
        • Pay Your Monthly Premium on TimePay Your Monthly Premium on Time
        • FIND A DOCTOR
        • MEMBER SIGN IN
        • SHOP FOR A PLAN
      • Easy Ways to PayEasy Ways to Pay
      • Understanding Your Premium BillUnderstanding Your Premium Bill
      • Grace PeriodGrace Period
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Medicare AdvantageMedicare Advantage
      • Medicare Advantage
      • Getting to Know MedicareGetting to Know Medicare
      • Understanding Pharmacy BenefitsUnderstanding Pharmacy Benefits
      • Staying HealthyStaying Healthy
      • Taking Care of Your HealthTaking Care of Your Health
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Member HandbooksMember Handbooks
    • Member Rights and ResponsibilitiesMember Rights and Responsibilities
    • NJ Individual MandateNJ Individual Mandate
    • Other Health Expense PlansOther Health Expense Plans
    • Pharmacy and PrescriptionsPharmacy and Prescriptions
      • Pharmacy and Prescriptions
      • Utilization ManagementUtilization Management
      • Prior AuthorizationPrior Authorization
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Unclaimed Property Due Diligence LetterUnclaimed Property Due Diligence Letter
    • Understanding Your CoverageUnderstanding Your Coverage
      • Understanding Your Coverage
      • Calculator for the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability ActCalculator for the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act
      • HCR (Health Care Reform) Preventive Care Information GuideHCR (Health Care Reform) Preventive Care Information Guide
      • How to Find an In-Network Provider, Care Facility or PharmacyHow to Find an In-Network Provider, Care Facility or Pharmacy
      • Learn more about your pharmacy benefitsLearn more about your pharmacy benefits
      • Navigating the Health NetworkNavigating the Health Network
      • Out-of-Network PaymentsOut-of-Network Payments
      • Qualifying Life EventsQualifying Life Events
      • Staying In NetworkStaying In Network
      • The Role of Your Primary Care Physician or Personal DoctorThe Role of Your Primary Care Physician or Personal Doctor
      • Third Party Designation for Senior Citizen InsuredsThird Party Designation for Senior Citizen Insureds
      • Understanding the ExchangeUnderstanding the Exchange
      • Understanding Your CostsUnderstanding Your Costs
      • Urgent care centers: an alternative to the Emergency RoomUrgent care centers: an alternative to the Emergency Room
      • Who to Contact When You Have a QuestionWho to Contact When You Have a Question
      • Young Adults - Own Your HealthYoung Adults - Own Your Health
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Understanding Your OMNIA Health PlanUnderstanding Your OMNIA Health Plan
      • Understanding Your OMNIA Health Plan
      • Accessing Doctors and HospitalsAccessing Doctors and Hospitals
      • Get Answers to Your QuestionsGet Answers to Your Questions
      • Getting the Most From Your OMNIA Health PlanGetting the Most From Your OMNIA Health Plan
      • Welcome VideoWelcome Video
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Your Guide to Getting CareYour Guide to Getting Care
      • Your Guide to Getting Care
      • What Does My Plan Cover?What Does My Plan Cover?
      • My Member ID CardMy Member ID Card
      • Where Can I Get Care?Where Can I Get Care?
      • Getting Ready for My AppointmentGetting Ready for My Appointment
      • What Happens After My Appointment?What Happens After My Appointment?
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • Your Health in FocusYour Health in Focus
    • Preventive HealthPreventive Health
      • Preventive Health
      • Are You at Risk for Heart Disease?Are You at Risk for Heart Disease?
      • Have a chronic condition? Know your stroke riskHave a chronic condition? Know your stroke risk
      • How to beat back painHow to beat back pain
      • Improve your health – one breath at a timeImprove your health – one breath at a time
      • Mammogram Myths and FactsMammogram Myths and Facts
      • Preventive Health GuidelinesPreventive Health Guidelines
      • The Scoop on SupplementsThe Scoop on Supplements
      • Tips to Help You Get MovingTips to Help You Get Moving
      • Vaccines: Myth Versus FactVaccines: Myth Versus Fact
      • Your Health MattersYour Health Matters
      • Health TopicsHealth Topics
      • FIND A DOCTOR
      • MEMBER SIGN IN
      • SHOP FOR A PLAN
    • FIND A DOCTOR
    • MEMBER SIGN IN
    • SHOP FOR A PLAN
  • NewsNews
    • News
    • Member NewsMember News
    • FIND A DOCTOR
    • MEMBER SIGN IN
    • SHOP FOR A PLAN
  • FIND A DOCTOR
  • MEMBER SIGN IN
  • SHOP FOR A PLAN
  • Plans and Services

    • Away From Home Care Program

      Horizon Blue App

      Medical Plans

      Horizon Dental

      Horizon Vision

      Horizon Pharmacy

      Patient-Centered Programs

      Medicare

      Medicaid

      24/7 Nurse Line

      AbleTo Support Program

      Case Management

      Chronic Care Program

      Personal Health Assistant

      Horizon CareOnline

      Horizon Behavioral Health

      Horizon Supportive Care Program

      Coverage Outside New Jersey

      Identity Protection Services

      SHBP and SEHBP Members

      Horizon MyWay

      Cancer Program

      Pet Insurance

      Remote Patient Monitoring for COPD

  • Our Networks

    • Providers

      Care Facilities

      Urgent Care Centers

      Sanitas Medical Centers

      Clinical Laboratory Services

      Pharmacies

      Horizon Care at Home

      Radiology/Cardiology Imaging

  • Tools

    • Connect With Us Online

      Our secure member website

      Doctor and Hospital Finder

      Treatment Cost Estimator

      Horizon MyWay

      The Power of Paperless

      Horizon Blue App

  • Forms

    • Search by Form Type

      Search by Frequently Used Forms

      Search by Plan Type

  • Wellness

    • My Health Manager

      Living and Savings

      Maternity Program

  • Education Center

    • Advance Directive

      Coverage decisions

      Gaining a better understanding of Prosthetics

      Making a Payment

      Medicare Advantage

      Member Handbooks

      Member Rights and Responsibilities

      NJ Individual Mandate

      Other Health Expense Plans

      Pharmacy and Prescriptions

      Unclaimed Property Due Diligence Letter

      Understanding Your Coverage

      Understanding Your OMNIA Health Plan

      Your Guide to Getting Care

      Your Health in Focus

      Preventive Health

  • News

    • Member News

  1. Home
  2. ›Members
  3. ›Forms
  4. ›Search by Form Type
Search by Form TypeSearch by Form Type
Appeal / Dispute Forms
Authorization Forms
Claim Forms
Enroll / Elect / Apply Forms
Inquiry / Request Forms
Manage Private Information Forms
Prescription Drug Mail Order Forms
Search by Frequently Used FormsSearch by Frequently Used Forms
Dental Forms
Manage Private Information Forms Manage Private Information Forms
Authorization for Disclosure OR Request For Access to Protected Health Information
HIPAA - Request to Represent a Deceased Member
HIPAA - Request to Terminate Personal Representative
HIPAA Request for Appointment of Personal Representative
Request for Accounting of Disclosures
Request for Amendment of Private Information
Medical Forms
Prescription Forms
Search by Plan TypeSearch by Plan Type
Away from Home Care Forms
Dental Forms
Horizon NJ TotalCare (HMO D-SNP) Forms
Medical Forms
Pharmacy Forms
Spending / Savings Account Forms

HIPAA - Request to Terminate Personal Representative

Attachment
horizon_bcbsnj_fillable_8072a.pdf
Horizon Blue Cross Blue Shield of New Jersey #1 in Member Satisfaction among
Commercial Health Plans in NJ, 3 out of 4 Years
  • ‌
  • ‌
  • ‌
  • ‌
  • ‌
  • ‌

This website is operated by Horizon Blue Cross Blue Shield of New Jersey and is not the Health Insurance Marketplace website. This website does not display all Qualified Health Plans available through the Health Insurance Marketplace website. To see all available Qualified Health Plan options, go to the Health Insurance Marketplace website at HealthCare.gov

Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross and Blue Shield Association.

For J.D. Power 2020 award information, visit jdpower.com/awards.

Information in other Languages

  • Español
  • 中文
  • 한국어
  • Tagalog
  • ગુજરાતી
  • Polski
  • Italiano
  • Русский язык
  • हिंदी
  • Français
  • عربي
  • اردو
  • Português
  • Kreyòl ayisyen
  • Tiếng Việt
  • Privacy Center
  • Claims Payment Policies and Other Information
  • Notice of Non-Discrimination
  • Horizon BCBSNJ Employees
  • Horizon BCBSNJ Retirees
NCQA Accredited Health Plan CAQH opens in a new window

Are you sure you want to leave this website?

You are leaving the Horizon Blue Cross Blue Shield of New Jersey website. Please click Continue to leave this website. Or, if you would like to remain in the current site, click Cancel.

CONTINUE link