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New Jersey Small Employer Member Enrollment/Change Request Form HP Oxford Health Plans (NJ), Inc. Mailing Address: P.O. Box 7085, Bridgeport, CT 06601-7085 1-800-444-6222 www.oxfordhealth.com INSTRUCTIONS

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A New Jersey large member refers to a business entity that meets the specific criteria set by the state of New Jersey in terms of size and annual revenue.

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