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ENROLLMENT/CHANGE REQUEST Horizon BCBS NJ Dental Programs A. Type of Activity P.O. Box 1938 Newark, NJ 07101-1938 www.HorizonBlue.com/dental 1-800-4DENTAL Group Information To Be Completed by Employer
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How to fill out horizon dental enrollmentchange request

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How to fill out horizon dental enrollment change request:

01
Visit the Horizon Dental website or contact their customer service to obtain the enrollment change request form.
02
Fill out the necessary personal information section, including your name, address, contact details, and insurance policy number.
03
Indicate the reason for the enrollment change request, whether it is adding a dependent, removing a dependent, or updating personal information.
04
Provide the requested information for the changes you are requesting. This may include the name, date of birth, and relationship to the policyholder for dependents being added or removed.
05
If you are updating personal information, such as a change in address or contact details, ensure that you provide the new and accurate information.
06
Review the completed form to ensure all information is correctly filled out and legible.
07
Attach any required supporting documents, such as birth certificates or marriage certificates, if applicable.
08
Sign and date the enrollment change request form.
09
Submit the completed form either through mail, fax, or online, following the instructions provided by Horizon Dental.

Who needs horizon dental enrollment change request:

01
Individuals who want to add or remove dependents from their Horizon Dental insurance policy.
02
Policyholders who need to update their personal information, such as a change in address or contact details.
03
Anyone who has experienced a life event, such as getting married or having a child, that requires them to update their dental insurance coverage.
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Horizon dental enrollmentchange request is a form that allows individuals to make changes to their dental insurance coverage with Horizon Dental.
Any individual who wishes to make changes to their dental insurance coverage with Horizon Dental is required to file a horizon dental enrollmentchange request.
To fill out a horizon dental enrollmentchange request, individuals can obtain the form from Horizon Dental's website or contact their customer service department. The form must be completed with accurate and updated information regarding the requested changes to dental insurance coverage.
The purpose of a horizon dental enrollmentchange request is to allow individuals to make changes to their dental insurance coverage with Horizon Dental. This includes adding or removing dependents, changing coverage levels, or updating personal information.
The horizon dental enrollmentchange request form requires individuals to report their personal information, such as name, address, and contact details. Additionally, individuals must provide information about the changes they wish to make to their dental insurance coverage, such as the names and details of any dependents being added or removed.
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