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Download the COVID-19 Resource Guide (as of March 27, 2023), created especially for our valued customers.

Claim

Blue Cross Blue Shield Global Core Forms › If you are looking for Blue Cross Blue Shield Global Core forms, click here. Please have your ID prefix ready to enter before searching for your plan form opens in a new window

PDF  Claim Form - Spending-Savings Accounts - Flexible Spending Account - Medical and Dependent Care

This form is used to file a Horizon BCBSNJ Flexible Spending Account (FSA) claim. ID: 6051

PDF  Claim Form - Spending-Savings Accounts - Flexible Spending Account - Transportation

Use this form to file a Horizon BCBSNJ Flexible Spending Account (FSA) transportation expenses claim. ID: 132

PDF  Claim Form - Spending-Savings Accounts - Health Reimbursement Account

This form is used to file a Horizon Health Reimbursement Account (HRA MyWay) claim. ID: 2816

PDF  Horizon Health Insurance Claim Form

Horizon HMO, Horizon POS, Horizon Direct Access, Horizon EPO, Horizon PPO, Traditional, National Accounts and OMNIA Health Plan members use this form for medical claims. ID: 7190

PDF  Prescription Drug Claim Form

Use this claim form to submit eligible pharmacy expenses for reimbursement. You have to submit one claim form for each person and each prescription. Full instructions can be found on page 2. ID: 3272 NJ 04/23