Medical Forms

 Claim Form - 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 - BlueCard

Members use this form to file a claim if they received covered medical services outside the U.S., Puerto Rico, and the U.S. Virgin Islands. ID: N-12-420

 Claim Form - PPO / Traditional Plans

Members of Horizon BCBSNJ PPO or Traditional plans use this form to file claims. ID: 7190

 Claim Form - National Accounts

National Account members use this form to file a medical claim. ID: 6044