Claim forms and claims-related forms.
Blue Cross Blue Shield Global Core Forms
If you need to file a claim for services provided outside of the United States, you can obtain the necessary forms from the Blue Cross Blue Shield Global Core website. Please have your ID prefix ready to enter before searching for your plan form.
Coordination of Benefits
This form authorizes Horizon BCBS to obtain any and all medical records and information from providers of service and/or hospitals, relating to the subscriber and eligible dependents, to the extent required to administer the Plan.
ID: 3247 (W0312)
Formulario de Reclamaciones de Seguros Médicos para Cuentas Nacionales
ID: ID 3200 (w1106)
Horizon Medical Health Insurance Claim Form
When you are submitting expenses for more than one family member, please use a separate claim form for each person. It is suggested that you make copies for your own use before you submit the original bills.
ID: 7190 (0319)
Medical Transition Care Benefit Request for Honeywell Group Members
ID: HONEYWELL (W0116)
Request for Continuance of Enrollment for a Disabled Dependent
ID: 9429 (W0718)