Medical


Claim forms and claims-related forms.


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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)


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.