Claim
Claim Form - Medical - HMO-POS-Direct Access – EPO – OMNIA Health Plans
Horizon HMO, Horizon POS and Horizon Direct Access, Horizon EPO and OMNIA Health Plan members use this form for medical claims. ID: 0834
Claim Form - Medical - PPO-Traditional
Members of Horizon BCBSNJ PPO or Traditional plans use this form to file claims. ID: 7190
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
Prescription Drug Claim Form - Prime Therapeutics
Use this claim form for prescriptions filled by Prime Therapeutics. Prime Therapeutics LLC is an independent company providing pharmacy benefit management services for Horizon BCBSNJ members. ID: 3272
