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Horizon application 2026

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101 votes

The document provides detailed instructions for small employers in New Jersey applying for health insurance coverage through Horizon Blue Cross Blue Shield. It outlines the necessary forms to be completed, including the Small Employer Health Benefits Policy Application and Certification, as well as additional required documents based on group size and payment methods. The document emphasizes the importance of accurate information submission and includes guidelines for enrollment, premium payments, and compliance with federal regulations.

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Click ‘Get Form’ to open the horizon application in the editor.
Begin by filling out Section I: Policyholder Information. Enter the full legal name of your company, Tax Identification Number, and main address. Ensure all fields are completed accurately.
Proceed to Section II: Specifications for Coverage. Select your desired health benefits options and any stand-alone pediatric dental options that apply to your group.
In Section III, answer all questions regarding current or prior group health plans. Provide details about any existing coverage and ensure you indicate if this application is replacing another plan.
Complete Section IV with agent/producer information, ensuring signatures are obtained where necessary.
Finally, review Section V for signature requirements. Confirm that all information is accurate before submitting the application through our platform.

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Versions	Form popularity	Fillable & printable
2023	4.2 Satisfied (49 Votes)
2022	4.8 Satisfied (55 Votes)
2020	4.8 Satisfied (247 Votes)
2020	4.2 Satisfied (36 Votes)
2020	4.8 Satisfied (101 Votes)
2020	4.4 Satisfied (134 Votes)
2020	4.3 Satisfied (26 Votes)
2020	4.7 Satisfied (51 Votes)
2020	4.8 Satisfied (261 Votes)
2020	4.1 Satisfied (59 Votes)
2020	4.8 Satisfied (117 Votes)
2019	4.8 Satisfied (35 Votes)
2019	4.8 Satisfied (142 Votes)
2019	4.8 Satisfied (54 Votes)
2019	4.8 Satisfied (51 Votes)

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