Get the free Horizon BC/BS Enrollment Form

Attn: Small Group Enrollment P.O. Box 607 Department A Newark, NJ 071010607 Fax (973) 2742227 www.HorizonBlue.comGROUP ENROLLMENT/CHANGE REQUEST Group Information to be completed by Employer. C. Employee

How to fill out horizon bcbs enrollment form

How to fill out horizon bcbs enrollment form

1. To fill out the Horizon BCBS enrollment form, follow these steps:
2. Start by downloading the enrollment form from the Horizon BCBS website.
3. Open the form in a PDF reader or print it out if you prefer to fill it out by hand.
4. Provide your personal information, such as your full name, date of birth, and contact details.
5. Fill out the sections regarding your employment information, including your employer's name and address.
6. Indicate the type of coverage you want by selecting the appropriate plan option.
7. Provide information about any dependents you want to include in your coverage.
8. If necessary, fill out the sections related to previous insurance coverage and any special circumstances.
9. Review the completed form to ensure all the information is accurate.
10. Sign and date the form to certify that the information provided is true and complete.
11. Submit the enrollment form to Horizon BCBS by following the instructions provided.

Who needs horizon bcbs enrollment form?

1. Anyone who wishes to enroll in a health insurance plan offered by Horizon BCBS needs to complete the enrollment form.
2. This includes individuals who want to apply for coverage for themselves as well as those who want to include their dependents in the same plan.
3. Whether you are a new member or an existing member making changes to your coverage, the enrollment form is necessary to communicate your preferences to Horizon BCBS.

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What is horizon bcbs enrollment form?

Horizon BCBS enrollment form is a form used to enroll in health insurance coverage provided by Horizon Blue Cross Blue Shield.

Who is required to file horizon bcbs enrollment form?

Anyone eligible for coverage through Horizon Blue Cross Blue Shield is required to file the enrollment form.

How to fill out horizon bcbs enrollment form?

To fill out the Horizon BCBS enrollment form, you need to provide personal information, contact details, and choose a plan option that best suits your needs.

What is the purpose of horizon bcbs enrollment form?

The purpose of the Horizon BCBS enrollment form is to enroll individuals in health insurance coverage provided by Horizon Blue Cross Blue Shield.

What information must be reported on horizon bcbs enrollment form?

The horizon BCBS enrollment form requires information such as personal details, contact information, plan selection, and any relevant medical history.