RESOURCE CENTER

Installation Forms
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2017 Small Employer Waiver of Coverage (SEH)
For all 2017 business, the following updated small group applications must be used or the group will be rejected by Horizon's compliance department. Waiver form for new business and conversions.
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2017 Small Employer Certification form (SEH)
For all 2017 business, the following updated small group applications must be used or the group will be rejected by Horizon's compliance department. Required for new business and annually prior to group's annievrsary.
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2017 Vision Employer Application
For all 2017 business, the following updated small group applications must be used or the group will be rejected by Horizon's compliance department. This is ER app for new vision business submissions.
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2017 Dental Employer Application
For all 2017 business, the following updated small group applications must be used or the group will be rejected by Horizon's compliance department. This is ER app for new dental business submissions.
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2017 Small Group Employer Application (SEH)
For all 2017 business, the following updated small group applications must be used or the group will be rejected by Horizon's compliance department. This is ER app for new medical business submissions.
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07.01.2015
Small Employer Employee Application (SEH)
Horizon branded Employee enrollment form needed for new business or existing member changes/terminations. Also used for NJ HINT - Dependent to 31 enrollments.
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01.30.2013
Conversion (Renewal) Form
Horizon branded form to be submitted with any renewal request where employer is looking to change benefits, or migrate members from one sub-group to another. Must be submitted with desired renewal quote option.
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12.05.2012
Horizon 2013 Cutoff Dates
Listing of possible effective dates for all of 2013 for new business and conversion business, and their respective cutoff dates. Please be advised Horizon will hold firm to these dates, as exceptions are rarely granted.
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05.08.2012
Horizon 2012 Cutoff Dates
Listing of possible effective dates for all of 2012 for new business and conversion business, and their respective cutoff dates. Please be advised Horizon will hold firm to these dates, as exceptions are rarely granted.
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05.03.2012
Confirmation of HSA Funding form (SEH)
REQUIRED form for any new group or conversion adding an HSA plan.
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02.15.2012
Horizon 2Q 2012 Cutoff Dates
Listing of possible effective dates thru 2Q 2012 for new business and conversion business, and their respective cutoff dates. Please be advised Horizon will hold firm to these dates, as exceptions are rarely granted.
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12.14.2011
Horizon 1Q 2012 Cutoff Dates
Listing of possible effective dates in 1Q 2012 for new business and conversion business, and their respective cutoff dates. Please be advised Horizon will hold firm to these dates, as exceptions are rarely granted.
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03.29.2011
Horizon Paperwork checklist (SEH)
Horizon branded checklist for new business and conversions. Helpful piece contains small details which are overlooked and will delay processing of case.
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03.23.2011
Small Employer Verification form for 2-5 eligible groups (SEH)
Horizon branded form for new business when a 2-5 eligible group does not have tax documentation or payroll
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03.23.2011
Small Employer Student Verification guidelines (SEH)
Horizon branded guidelines for their Full-time student verification process
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