Forms Library - Individual
Horizon BCBSNJ
Administrative Forms
- Deductible Carryover Credit Form
- How to Read EOB
- IHC Off-Marketplace Health Benefits Plans Broker Manual
- Special Enrollment Check Off List
Brochures
- 2023 Horizon IHC Medical & Dental Rates
- 2023 Horizon IHC Plan Guide
- Blue365 FAQ Sheet
- Blue365 Flyer
- Blue365 Healthways Enrollment Flyer
- Blue365 Healthy Discounts
- Horizon Blue Mobile App ID Card Flyer
- Identity Protection Services
- OMNIA Top 10 Tips
- Precious Additions Maternity Health
- Preventive Health Guidelines
- Preventive Healthcare Mandate Flyer
- Provider Counts in NJ July 2022
- Small Group to IHC Sales Guide
- Telemedicine CareOnline Overview
- Telemedicine CareOnline Regulatory Enviornment
- Urgent Care Options
Broker of Record Letters
Dental
- Centurion Dental Enrollment Form
- Dental Grid & Grid Plus Information
- Dental Networks - Product Overview
- Dental Trifold
- Horizon Dental Networks individual
- Horizon Dental Search Tools
- Horizon Individual Dental Plan Enrollment Application
- IHC Dental Plan Guide and Rates
Enrollment
- 2023 Dental & Vision Application SPANISH
- 2023 Dental & Vision Application ENGLISH
- 2023 Horizon IHC Medical Enrollment Form
- 2023 Horizon Individual Dental Enrollment Form ENGLISH
- 2023 Horizon Individual Dental Enrollment Form SPANISH
- 2023 Horizon Medical Enrollment Form SPANISH
- 2023 IHC Termination Request Form
- Away From Home Care Application
- Dental & Vision Enrollment Form
- Individual SAPD Enrollment Form
- Request of Enrollment for Disabled Dependent
Prescription
Vision