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Dental Claim Form

Use this form to file a Horizon Dental plan claim or to request an up-to-date report of a member∍s dental benefits so they can plan for future dental expenses.

ID: 7902 (W0113)

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Authorization for Disclosure of Protected Health Information (PHI) - Dental Only

Use this form to authorize the use and disclosure of a member∍s dental Protected Health Information that is held by Horizon BCBSNJ and its business associates.

ID: 5418 (W0212)

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Dental Recruiting Request Form

Give this form to a dentist to invite him/her to join one or more Horizon BCBS dental networks.

ID: 9652