Dental Forms
Need a dental form? Our dental forms are located in one convenient location.
Alert
Toggle menu
- BACKback to www.horizonblue.com
- MEMBERS
-
Plans & ServicesPlans & Services
- Plans & Services
- Away From Home Care ProgramAway From Home Care Program
- Horizon Blue AppHorizon Blue App
-
Medical PlansMedical Plans
- Medical Plans
- BlueCard PPOBlueCard PPO
- EPO (Exclusive Provider Organization)EPO (Exclusive Provider Organization)
- Horizon Direct AccessHorizon Direct Access
- Horizon HMOHorizon HMO
- Horizon MyWayHorizon MyWay
- Horizon POS (Point of Service)Horizon POS (Point of Service)
- OMNIA Health PlansOMNIA Health Plans
- Traditional IndemnityTraditional Indemnity
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Horizon DentalHorizon Dental
- Horizon VisionHorizon Vision
-
Horizon PharmacyHorizon Pharmacy
- Horizon Pharmacy
- Flu Shots & Other ImmunizationsFlu Shots & Other Immunizations
- Generic DrugsGeneric Drugs
- Orally Administered Cancer Medication Coverage LawOrally Administered Cancer Medication Coverage Law
- Home Delivery Pharmacy ServiceHome Delivery Pharmacy Service
-
Prescription Drug ListsPrescription Drug Lists
- Prescription Drug Lists
- Classic Drug List for the ExchangeClassic Drug List for the Exchange
- Classic Drug ListClassic Drug List
- Fertility Drug ListFertility Drug List
- Office-Administered Specialty Medications ListOffice-Administered Specialty Medications List
- Orally Administered Cancer MedicationsOrally Administered Cancer Medications
- PA Medical Necessity Drug ListPA Medical Necessity Drug List
- Patient Protection and Affordable Care Act Preventive Drug ListPatient Protection and Affordable Care Act Preventive Drug List
- Self-Administered Specialty Medicine ListSelf-Administered Specialty Medicine List
- NetResults Drug ListNetResults Drug List
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Specialty RxSpecialty Rx
- Specialty Rx
- Specialty Pharmaceutical Pharmacy BenefitSpecialty Pharmaceutical Pharmacy Benefit
- Specialty Pharmaceutical for Office AdministrationSpecialty Pharmaceutical for Office Administration
- Specialty Rx Program for Infertility TreatmentSpecialty Rx Program for Infertility Treatment
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Patient-Centered ProgramsPatient-Centered Programs
- MedicareMedicare
- MedicaidMedicaid
- 24/7 Nurse Line24/7 Nurse Line
- AbleTo Support ProgramAbleTo Support Program
- Case ManagementCase Management
- Chronic Care ProgramChronic Care Program
- Personal Health AssistantPersonal Health Assistant
- Horizon CareOnlineHorizon CareOnline
- Horizon Behavioral Health℠Horizon Behavioral Health℠
- Horizon Supportive Care ProgramHorizon Supportive Care Program
- Coverage Outside New JerseyCoverage Outside New Jersey
- Identity Protection ServicesIdentity Protection Services
- SHBP and SEHBP MembersSHBP and SEHBP Members
- Horizon MyWayHorizon MyWay
- Cancer ProgramCancer Program
- Pet InsurancePet Insurance
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Our NetworksOur Networks
- Our Networks
- ProvidersProviders
- Care FacilitiesCare Facilities
- Urgent Care CentersUrgent Care Centers
- Sanitas Medical CentersSanitas Medical Centers
- Clinical Laboratory ServicesClinical Laboratory Services
- PharmaciesPharmacies
- Horizon Care@HomeHorizon Care@Home
- Radiology/Cardiology ImagingRadiology/Cardiology Imaging
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
ToolsTools
- Tools
- Connect With Us OnlineConnect With Us Online
- Our secure member websiteOur secure member website
- Doctor & Hospital FinderDoctor & Hospital Finder
- Treatment Cost EstimatorTreatment Cost Estimator
- Horizon MyWayHorizon MyWay
- The Power of PaperlessThe Power of Paperless
- Horizon Blue AppHorizon Blue App
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
FormsForms
- Forms
-
Search by Form TypeSearch by Form Type
- Search by Form Type
- Appeal / Dispute FormsAppeal / Dispute Forms
- Authorization FormsAuthorization Forms
- Claim FormsClaim Forms
- Enroll / Elect / Apply FormsEnroll / Elect / Apply Forms
- Inquiry / Request FormsInquiry / Request Forms
- Manage Private Information FormsManage Private Information Forms
- Prescription Drug Mail Order FormsPrescription Drug Mail Order Forms
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Search by Frequently Used FormsSearch by Frequently Used Forms
- Search by Frequently Used Forms
- Dental FormsDental Forms
-
Manage Private Information FormsManage Private Information Forms
- Manage Private Information Forms
- Authorization for Disclosure OR Request For Access to Protected Health InformationAuthorization for Disclosure OR Request For Access to Protected Health Information
- HIPAA - Request to Represent a Deceased MemberHIPAA - Request to Represent a Deceased Member
- HIPAA - Request to Terminate Personal RepresentativeHIPAA - Request to Terminate Personal Representative
- HIPAA Request for Appointment of Personal RepresentativeHIPAA Request for Appointment of Personal Representative
- Request for Accounting of DisclosuresRequest for Accounting of Disclosures
- Request for Amendment of Private InformationRequest for Amendment of Private Information
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Medical FormsMedical Forms
- Prescription FormsPrescription Forms
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Search by Plan TypeSearch by Plan Type
- Search by Plan Type
- Away from Home Care FormsAway from Home Care Forms
- Dental FormsDental Forms
- Horizon NJ TotalCare (HMO D-SNP) FormsHorizon NJ TotalCare (HMO D-SNP) Forms
- Medical FormsMedical Forms
- Pharmacy FormsPharmacy Forms
- Spending / Savings Account FormsSpending / Savings Account Forms
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
WellnessWellness
- Wellness
- My Health ManagerMy Health Manager
- Living & SavingsLiving & Savings
-
Maternity ProgramMaternity Program
- Maternity Program
- Maternity Health CoachMaternity Health Coach
- My Pregnancy AssistantMy Pregnancy Assistant
- Postpartum DepressionPostpartum Depression
- Is Breastfeeding Right for You and Your Baby?Is Breastfeeding Right for You and Your Baby?
- Enrollment FormEnrollment Form
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Education CenterEducation Center
- Education Center
- Advance DirectiveAdvance Directive
- Gaining a better understanding of ProstheticsGaining a better understanding of Prosthetics
- Making a PaymentMaking a Payment
- Medicare AdvantageMedicare Advantage
- Member HandbooksMember Handbooks
- Member Rights and ResponsibilitiesMember Rights and Responsibilities
- NJ Individual MandateNJ Individual Mandate
- Other Health Expense PlansOther Health Expense Plans
- Pharmacy & PrescriptionsPharmacy & Prescriptions
- Unclaimed Property Due Diligence LetterUnclaimed Property Due Diligence Letter
-
Understanding Your CoverageUnderstanding Your Coverage
- Understanding Your Coverage
- Calculator for the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability ActCalculator for the Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act
- HCR (Health Care Reform) Preventive Care Information GuideHCR (Health Care Reform) Preventive Care Information Guide
- How to Find an In-Network Provider, Care Facility or PharmacyHow to Find an In-Network Provider, Care Facility or Pharmacy
- Learn more about your pharmacy benefitsLearn more about your pharmacy benefits
- Navigating the Health NetworkNavigating the Health Network
- Out-of-Network PaymentsOut-of-Network Payments
- Qualifying Life EventsQualifying Life Events
- Staying In NetworkStaying In Network
- The Role of Your Primary Care Physician or Personal DoctorThe Role of Your Primary Care Physician or Personal Doctor
- Third Party Designation for Senior Citizen InsuredsThird Party Designation for Senior Citizen Insureds
- Understanding the ExchangeUnderstanding the Exchange
- Understanding Your CostsUnderstanding Your Costs
- Urgent care centers: an alternative to the Emergency RoomUrgent care centers: an alternative to the Emergency Room
- Who to Contact When You Have a QuestionWho to Contact When You Have a Question
- Young Adults - Own Your HealthYoung Adults - Own Your Health
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Understanding Your OMNIA Health PlanUnderstanding Your OMNIA Health Plan
- Understanding Your OMNIA Health Plan
- Accessing Doctors and HospitalsAccessing Doctors and Hospitals
- Get Answers to Your QuestionsGet Answers to Your Questions
- Getting the Most From Your OMNIA Health PlanGetting the Most From Your OMNIA Health Plan
- Welcome VideoWelcome Video
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
-
Your Guide to Getting CareYour Guide to Getting Care
- Your Guide to Getting Care
- What Does My Plan Cover?What Does My Plan Cover?
- My Member ID CardMy Member ID Card
- Where Can I Get Care?Where Can I Get Care?
- Getting Ready for My AppointmentGetting Ready for My Appointment
- What Happens After My Appointment?What Happens After My Appointment?
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Your Health in FocusYour Health in Focus
-
Preventive HealthPreventive Health
- Preventive Health
- Are You at Risk for Heart Disease?Are You at Risk for Heart Disease?
- Have a chronic condition? Know your stroke riskHave a chronic condition? Know your stroke risk
- Improve your health – one breath at a timeImprove your health – one breath at a time
- Mammogram Myths and FactsMammogram Myths and Facts
- Preventive Health GuidelinesPreventive Health Guidelines
- The Scoop on SupplementsThe Scoop on Supplements
- Your Health MattersYour Health Matters
- Health TopicsHealth Topics
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- NewsNews
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
