Bridgewater-Raritan Regional School District

Find the most frequently used carrier forms you need right here - just click and print!


Claim Forms
Horizon BCBSNJ Medical Claim Form
Horizon BCBSNJ / Prime Therapeutics Claim Form
Delta Dental Claim Form

WEX Claim Form

Enrollment Forms  

Horizon BCBSNJ Group Enrollment / Change Request
Medical Coverage Form (for employees enrolling in Horizon Direct Access 10)
Bus Drivers Medical Coverage Form (for Bus Drivers enrolling in medical plan other than DA 20/35 base plan)
Delta Dental Enrollment / Change Request Form
WEX FSA Data Collection Worksheet
Worksheet Instructions

2024/25 Opt-Out Election Form
AllianceRx PrimeMail+Walgreens Mail-Service Form

Delta Dental Student Verification Form
WEX FSA Recurring Dependent Care Request Form
GSP Statement Form