Forms Library - Small Group
Horizon BCBSNJ
Administrative Forms
- 2-5 Employee Eligibility Form
- Automatic Pay Form for Groups
- Claim Form - Horizon
- Compensation Disclosure Form
- Deductible Carryover Credit form
- Emergency_Grace_Period_Premium_Deferral_Program_Agreement Rev 4-23-20
- How to Read EOB
- International-Claim-Form-US-2024-Update-Fillable-8x11
- New Group Submission Checklist
- SE Common Ownership Certification
- SEH Off-Marketplace Health Benefits Plans Broker Manual
Brochures
- 2025 Small Group Products Overview
- Access Your Member ID Anytime with App (English)
- Access Your Member ID Anytime with App (Spanish)
- Blue365 FAQ Sheet
- Blue365 Healthways Enrollment Flyer
- Blue365 Healthy Discounts
- Blue365 Member Flyer
- BlueCard Brochure
- BlueCard Worldwide
- Enrollment Guide_ Horizon Advantage EPO with BlueCard (ECN006513)
- GeoBlue All Product Spotlight
- Horizon Blue Mobile App
- Horizon Nurse Line Flyer
- Largest Network
- MindCare flyer_v6_10.2023
- MindCare Introducing
- OMNIA Top 10 Tips
- Precious Additions Maternity Health
- Preventive Health Guidelines
- Preventive Healthcare Mandate Flyer
- Provider Counts January 2023 - Unique NJ
- Small Group Broker Flyer
- Telemedicine CareOnline Overview
- Telemedicine CareOnline Regulatory Environment
- Urgent Care Options
Broker of Record Letters
Dental
- Dental Basic Companion Highlights
- Dental Companion Highlights
- Dental Employee Enrollment Form
- Dental Employer Application
- Dental Grid & Grid Plus Information
- Dental Networks - Product Overview
- Dental Option Plan Summary of Benefits
- Dental Trifold
- Horizon Dental Networks v3
- Horizon Dental Search Tools
- Small Group Dental Products Brochure
Enrollment
- Away From Home Application
- Continuity of Care Coverage Agreement
- Employer Conversion Form
- Employer NJ Certification Form
- Enrollment/Change Form Small Employer-Fillable
- For Enrollment for Disabled Dependent
- Horizon Enrollment cheat sheet 1-16-25
- Permanent Disability Enrollment Form
- Request for Treatment as an AEI for NJ Continuation
- Small Employer Group Application
- Spanish Waiver of Coverage
- Waiver of Coverage
Health Plus Plan
- Family Grins Benefit Summary
- Family Grins Plus Benefit Summary
- Overview Health Plus Plan
- Small Employer Health Plus Plan Employer Application
- Small Employer Health Plus Plan Employer Application With Medical
HSA Information
- 2024 HSA Employer Sheet
- 2024 HSA Essential Guide
- 2024 HSA Fact Sheet
- 2024 HSA Worksheet
- BenefitWallet HSA Info Flyer
- BenefitWallet Opeing Your HSA Flyer
- Confirmation of Funding
- Horizon HSA Employee Contribution Election Form
- HSA Advantage Direct Account Opening
- Mellon NJ Small Employer Discovery Doc.
- Member Website MyWay HSA
- MyWay HSA Employer Application
- NJ Declaration of Understanding
Level Select
Prescription
Vision