How to Complete and Submit the Horizon BCBSNJ Small Group Enrollment Form

To set up group health coverage with Horizon Blue Cross Blue Shield of New Jersey, you complete the state’s small group master application (the NJ-GR-APP) together with an individual enrollment form for every employee taking coverage, a waiver form for every employee declining it, and payroll verification, then submit the full package to Horizon’s Small Group department. The Horizon BCBSNJ small group enrollment form is the same standardized state application used across the New Jersey Small Employer Health Benefits (SEH) Program, so the fields and rules below apply regardless of which Horizon product you select.

What to Gather Before You Start

Processing delays almost always trace back to missing paperwork or data that doesn’t match other records. Pull everything together first.

The NJ-GR-APP master application, available from Horizon’s employer forms page or a licensed broker.
One individual enrollment form for each employee enrolling.
One waiver of coverage form for each employee declining; the state’s standard waiver requires a reason for refusal.¹
Payroll verification. For groups of five or fewer eligible employees, this is the WR-30 (New Jersey quarterly wage report). If a WR-30 isn’t available, a K-1, Schedule C, or Form 1120 can substitute.
An ACH authorization form if you want automatic premium payments; this is optional but tends to speed ID card delivery.

For each employee, you need full legal name, Social Security number, date of birth, and home address. For the company, you need the Federal Tax Identification Number and the four-digit Standard Industrial Classification (SIC) code. If you don’t know your SIC code, OSHA has a lookup tool.²

Completing the Employer Section of the NJ-GR-APP

The employer section asks for the company’s legal name exactly as it appears on tax filings, the Federal TIN, and the SIC code.³ Check the business name against your most recent tax return before you write it in. A minor mismatch between the application and IRS records is one of the standard reasons a file gets kicked back for clarification.

You will also identify the benefit plan design the company is offering and sign a certification attesting that the business meets the program’s eligibility, participation, and contribution requirements. Type the form if you can. Handwritten entries that aren’t easily legible are another common cause of processing delays.

Employee Enrollments and Waivers

Each enrolling employee fills out their own enrollment form covering personal information, dependents, and coverage tier. The standard tiers are single, member/spouse, parent/child, and family.³ Dates of birth drive premium amounts, since small group rates are age-rated within a 3:1 ratio under federal law — the oldest adults in the group can be charged up to three times the rate of the youngest adults for the same plan.⁴

Waivers aren’t a formality. Any employee who declines coverage completes one, checking the reason: coverage under another group plan, a spouse’s employer plan, Medicare, Tricare, or another reason explained in writing.¹ The reason given affects whether that employee counts toward participation, which is what the next section is about.

Clearing Participation and Contribution Thresholds

The application is only accepted if the group clears two numeric tests. Both are built into state regulation, and both can quietly sink an otherwise clean application.

On participation, carriers must require at least 75 percent of full-time employees (those working 25 or more hours per week) to participate. Employees with other qualifying coverage — a spouse’s plan, Medicare, Medicaid, NJ FamilyCare, or Tricare — count as participating even when they waive, so the real bar applies to employees who have no other coverage. Most of those have to enroll for the group to qualify.⁵ This is why collecting a waiver (with the reason filled in) for every declining employee is as important as collecting the enrollments.

One timing exception matters. During the employer’s annual open enrollment period, the 75 percent requirement does not apply. If the group is borderline, aligning the application with open enrollment removes the hurdle.⁵

On contribution, state law caps what a carrier can demand from the employer at 10 percent of the annual cost of the plan. Many employers choose to pay much more, but 10 percent is the floor the certification on the NJ-GR-APP commits you to.⁶

Selecting the Plan Design on the Form

The SEH Program Board has adopted standardized plan designs (Plans B through E, plus standard HMO and HMO-POS). Every design covers inpatient and outpatient care, office visits, prenatal and maternity services, prescription drugs, mental health and substance abuse treatment, preventive screenings, and pediatric vision and dental.⁷ What varies is the network.

PPO. Covers in-network and out-of-network providers, with higher cost-sharing out of network.
POS. Similar to a PPO in covering both in-network and out-of-network services.
EPO. Network-only, except for emergencies and urgent care.
HMO. Network-only, except for emergencies.
HMO-POS. HMO with an out-of-network option.

The NJ-GR-APP asks you to indicate the design the company is offering. You select the Horizon product that matches the standard plan tier your broker has quoted.⁷

Submitting the Package

Once everything is signed, the full package goes to Horizon BCBSNJ’s Small Group department: master application, individual enrollments, waivers, payroll verification, and either the initial premium check or an ACH authorization. Horizon’s employer forms page lists current submission options, which include an online employer portal along with fax and mail.⁸ Portal URLs and fax numbers change periodically, so confirm the current channel with your broker or Horizon directly before sending.

Before the package leaves your desk, run through a short checklist:

Every employee has either an enrollment form or a waiver.
Social Security numbers match official records. Mismatched SSNs are among the most common reasons applications stall.
The business name on the NJ-GR-APP matches your tax filings exactly.
The TIN and SIC code are filled in.
Payroll verification (WR-30 or a listed substitute) is included if the group has five or fewer eligible employees.

Keep a complete copy of everything you submit in your permanent personnel files.

What Happens After You Submit

Small group coverage can generally start on the first of any month, so you have flexibility on the effective date. Under the Affordable Care Act, group health plans cannot impose a waiting period longer than 90 calendar days, meaning coverage for a new eligible employee must begin no later than the 91st day after they meet the plan’s eligibility conditions.⁹ The 90-day count includes weekends and holidays, starting on the hire date or the date the employee becomes eligible. A bona fide orientation period of up to one calendar month is permitted before the 90-day window begins, but using an orientation period to stretch the total gap beyond 90 days is where compliance problems come up.

After Horizon processes the application and issues a group number, member ID cards are mailed to employee home addresses. Digital versions are usually available through the Horizon member portal before the physical cards arrive, which helps for pharmacy visits or appointments scheduled in the first few days of coverage.

Who Can File This Form in the First Place

The NJ-GR-APP is for small employers as defined by New Jersey law: a business that employed an average of at least two but not more than 50 eligible employees on business days during the previous calendar year, still employs at least two on the first day of the plan year, and has the majority of those employees working in New Jersey.¹⁰ Sole proprietors with no employees do not qualify; the minimum is two.

Group size is counted with a formula. Each employee working 30 or more hours per week counts as one. For part-timers (under 30 hours), multiply each person’s weekly hours by four, add the products for all part-timers, divide the total by 120, and round down. If full-time plus the part-time result lands between 2 and 50, the business qualifies.¹¹

The SEH Program is guaranteed-issue, so once a qualifying employer meets the participation and contribution rules and pays the premium, the carrier must issue a policy. It cannot refuse the group based on the health status or claims history of any employee or dependent.¹²

1
Horizon Blue Cross Blue Shield of New Jersey. Small Employer Health Benefits Waiver of Coverage
2
Occupational Safety and Health Administration. Standard Industrial Classification (SIC) System Search
3
New Jersey Department of Banking and Insurance. Application for a Small Group Health Benefits Policy
4
Centers for Medicare & Medicaid Services. Market Rating Reforms
5
Legal Information Institute. New Jersey Administrative Code 11:21-7.5 – Participation Requirements
6
New Jersey Department of Banking and Insurance. New Jersey Administrative Code 11:21-7.6 – Contribution Requirements
7
New Jersey Department of Banking and Insurance. New Jersey Small Employer Health Benefits Program Buyer’s Guide
8
Horizon Blue Cross Blue Shield of New Jersey. Small Group Forms
9
U.S. Department of Labor. FAQs About Affordable Care Act Implementation Part XVI
10
Justia Law. New Jersey Revised Statutes Section 17B:27A-17
11
Legal Information Institute. New Jersey Administrative Code 11:21-7.2 – Determination of Small Employer Status
12
FindLaw. New Jersey Statutes Title 17B Insurance 17B 27A-19