Find-a-Form
Pompton Lakes School District
Find the most frequently used carrier forms you need right here - just click and print!
Note: send completed forms via interoffice mail to Health Benefits Administration (healthbenefits@plps.org).
Horizon BCBSNJ Medical:
Fillable PDF Enrollment Form
Fillable PDF Claim Form
BeneCard Prescription:
Enrollment Form
Dependents to Age 31 Enrollment Form
Mail Service Form
Direct Member Reimbursement Form
Delta Dental:
Fillable PDF Enrollment Form
Printable Enrollment Form
Claim Form
Student Verification Form
Other:
2024 Waiver Form
2024 CHIP Eligibility Notice