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Horizon NJ

You will need the forms that start with a plus sign (+) to process new business.

  • + Horizon NJ Health Plus Plan SEHPP Bundle Ancillary Only
  • + Horizon NJ Health Plus Plan SEHPP Bundle Medical and Ancillary
  • + Horizon NJ Small Employer Group Application 2023
  • + Horizon NJ Small Group Employee Enrollment-Change Form
  • + Horizon NJ Small Group Employer Certification
  • + Horizon NJ Small Group Waiver of Coverage
  • 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 HSA My Way Plan Design Guide
  • Horizon NJ Prime Rx Mail Order Form
  • Horizon NJ Prime Therapeutics Rx Claim Form
  • Horizon NJ Request Of Continuance For Disabled Dependent

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