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  • Horizon Enrollmentchange Request Form

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Attn Large and Mid-Size Group Enrollment Horizon Blue Cross Blue Shield of NJ PO BOX 10168 Group Name Newark NJ 07101-3168 ENROLLMENT/CHANGE REQUEST Group Information A. I hereby agree to the conditions on the reverse side of this enrollment/change request. I authorize deductions from my earnings for any required contributions. H. Employer Verification Employer Signature - Required X Date E-Mail Address Title Employee copy may be used as a tempor.

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Headquartered in West Trenton, N.J., Horizon NJ Health, is a wholly-owned subsidiary of the Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross Blue Shield Association. Learn more at .horizonNJhealth.com.

How do I change my mailing address? A. 1-800-701-0720. Tell the representative that your address has changed.

If you bought insurance directly from Horizon BCBSNJ: You must complete and return the Non-Group Enrollment/Change Request Form to change your coverage information, including adding or removing an eligible spouse or dependent, changing your name, changing your plan, and other Special Enrollment Period (SEP) related ...

How do I get my name corrected in your system? A. You need to call NJ FamilyCare toll free at 1-800-701-0710. If you have a speech or hearing difficulty, you can use the TDD/TTY service at 1-800-701-0720.

If your Horizon Blue Cross Blue Shield of New Jersey plan has the BlueCard® Program, you're covered when you need care across the United States.

If you purchased your insurance directly through Horizon: Use our Email Us tool. Under Category, choose Enrollment; Fax your information to 1-973-274-4413; or. Check the box titled Report Address Change and complete the information on your invoice when sending your premium payment by mail.

Claims must be submitted within 180 calendar days from the date of service. The claim will be denied if not received within the required time frames. Corrected claims must be submitted within 365 days from the date of service.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232