Forms Library - Small Group
Horizon BCBSNJ
Administrative Forms
- 2-5 Employee Eligibility Form
- Automatic Pay Form for Groups
- Claim Form - Horizon
- Claim Form for Managed Care
- Compensation Disclosure Form
- Deductible Carryover Credit form
- Emergency_Grace_Period_Premium_Deferral_Program_Agreement Rev 4-23-20
- Guest Membership Form
- How to Read EOB
- New Group Submission Checklist
- SE Common Ownership Certification
- SEH Off-Marketplace Health Benefits Plans Broker Manual
Brochures
- 2021 Small Group Overview 10-1-20
- 2022 Small Group Brochure - Spanish
- 2022-SmallGroup-Dynamic Brochure
- 2022-SmallGroup-Health-Plus-Plan-Brochure
- 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 Brochure
- GEOBlue Individual Products: Seller's Guide
- Horizon BFit and Blue365 Flyer 09.15.21.FINAL
- Horizon Blue Mobile App
- Horizon Care Online Flyer FLYER 06.30.21.FINAL
- Horizon Nurse Line Flyer
- Identity Protection Services
- OMNIA silver - gold plan flyer 5.5.20
- OMNIA Top 10 Tips
- Precious Additions Maternity Health
- Preventive Health Guidelines
- Preventive Healthcare Mandate Flyer
- Prime Mail Prescription Order Form 3208 (1)
- Small Group Broker Flyer
- Small-Group-Horizon-Level-Select Brochure-2.10.22-FINAL
- 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
- 2021 Small Employer Group Application
- 2021 Small Employer SHOP Application
- 2022 Small Employer Group Application
- 2022 Small Employer Health Options Program SHOP App
- 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
- Permanent Disability Enrollment Form
- Request for Treatment as an AEI for NJ Continuation
- Small Group Horizon Level Select Employer Application -Final 1-3-22
- Waiver of Coverage
Health Plus Plan
- 2021 HHPlus Plan with Medical Employer Application
- 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
- BenefitWallet HSA Info Flyer
- BenefitWallet Opeing Your HSA Flyer
- Confirmation of Funding
- HSA Advantage Direct Account Opening
- Mellon NJ Small Employer Discovery Doc.
- Member Website MyWay HSA
- MyWay HSA Employer Application
- NJ Declaration of Understanding
Prescription
- Pharmacy and Prescription Services Information
- Pharmacy Flyer
- Prime Prescription Claim Form
- Prime Prescription Mail Order Form
Vision