Forms
/ In-network
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Policyholder Services
Policyholders please complete the following form to request help on
servicing your
benefits. A representative will respond as soon as possible.
Change
Forms - Please print and complete the desired change
form from the list below. Return by scanned email , or fax to (732)842-6421 and or mail to
NJGroupHealth.com P.O. Box 301, Rumson, NJ 07760.
Aetna
AmeriHealth
Group Administrator Customer Service (800)893-7827
Insured Employee Customer Service - HMO, POS Plans (800)877-9829
PPO Plans (800)422-2457
Employer
Authorization For Access To Amerihealthexpress.com
Small
Employer Waiver Form
Employee
Enrolment Form
Enrollment
Report: Additions, Changes, and/or Removals
Student
Verification Form
Prior
Carrier deductible Credit Information Form
Personal
Choice Out-of-Network Claim Form
Point
of Service Claim Form
Prescription
Drug Claim Form
Broker
of Record Letter
Cigna
Group Member Services (800)462-6633
Enrollment/Change
Form
Waiver
Form
Broker
of Record Form
HealthNet
Horizon Blue Cross
Blue Shield of New Jersey
Group Administrator Customer Service (800)225-1955
Insured Employee Customer Service (800)355-2583
Employee
Application & Change Form
Waiver
Form
Enrollment
Change/Deletion Form
Claims
Form
Broker
of Record Form
Horizon Group Dental
Dental
Employee Application & Change Form
Dental
Service Report
Oxford Health Plans
United Healthcare
Inc.,
Group Administrator Customer Service (800)842-0163
Insured Employee Customer Service (888)847-2464
Employee
Application & Change Form
Waiver
Form
Broker
of Record Form
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