New Jersey SHBP members with NJ DIRECT use this form to file claims.
Use this form to request Transition Care benefits.
If new members (and/or covered family members) have met all or part of their deductible under a prior Medical plan, use this form to request that a credit be applied to their new plan.
This form authorizes Horizon BCBSNJ to report specific information about beneficiaries to the Centers for Medicare & Medicaid Services (CMS), as a CMS mandate requires of group health insurance plans. CMS uses this information to properly coordinate payment of benefits among health plans so that claims are paid accurately.
SHBP members in the New Jersey State Police use this form to provide medical history information.
ID: SP 117