Claim
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
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
Claim Form - Spending-Savings Accounts - Health Reimbursement Account
This form is used to file a Horizon Health Reimbursement Account (HRA MyWay) claim. ID: 2816
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
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