Get Intermittent Employees Group - State Of New Jersey - Nj

This guide provides clear, step-by-step instructions on how to complete the Intermittent Employees Group application for the New Jersey State Health Benefits Program online. Whether you are enrolling for the first time or making changes to your existing coverage, this guide aims to support you through the process.

Follow the steps to complete your application online.

1. Press the ‘Get Form’ button to access the application document. Ensure you have the necessary information on hand before proceeding.
2. Complete section 1 with your employee information. Fill in your last name, first name, middle initial, date of birth, gender, Social Security number, home telephone number, and address, making sure all fields are filled out completely.
3. In section 2, select your desired medical coverage. Indicate whether you want coverage under NJ PLUS, the Prescription Drug Plan, or both. If selecting NJ PLUS, provide your NJ PLUS Primary Care Physician's ID number.
4. Choose the level of NJ PLUS coverage you prefer in section 2b. Options include single, member and spouse/civil union partner, member and domestic partner, or family coverage.
5. If applicable, select your level of Prescription Drug Plan coverage in section 2c.
6. In section 3, indicate if you are waiving coverage for yourself or your dependents by checking the appropriate box.
7. Complete section 4 for dependent information. List all eligible dependents, including their names, dates of birth, genders, and Social Security numbers.
8. If applicable, fill out section 5 regarding any changes to existing coverage, such as adding or deleting dependents, and provide the necessary event dates.
9. Review section 6 and sign the Employee Certification to confirm that all information provided is accurate and truthful.
10. Ensure that your employer completes the Employer Certification part. Once all sections are filled out and verified, you may submit the application.
11. After submission, keep a copy for your records. Ensure to save changes, download, print, or share the form as needed.

Start your application process online today to ensure you receive the coverage you need.