You will need the forms that start with a plus sign (+) to process new business.
- + Horizon NJ Small Group Employee Enrollment-Change Form
- + Horizon NJ Small Group Master Application
- BenefitWallet HSA Employer Setup Form
- Horizon NJ Confirmation of HSA Selection
- Horizon NJ Conversion Request Form
- Horizon NJ Declaration of Understanding
- Horizon NJ Deductible Carry Over Form
- Horizon NJ Group Automatic Pay Plan Application
- Horizon NJ HMO POS Direct Access Medical Claim Form
- Horizon NJ Melon Set Up Document
- Horizon NJ Prime Rx Mail Order Form
- Horizon NJ Prime Therapeutics Rx Claim Form
- Horizon NJ Request Of Continuance For Disabled Dependent
- Horizon NJ Small Group Employer Certification
- Horizon NJ Small Group Waiver of coverage