Dental Forms
Need a dental form? Our dental forms are located in one convenient location.
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
- Horizon CareOnlineHorizon CareOnline
- Horizon Behavioral HealthHorizon Behavioral Health
- Coverage Outside New JerseyCoverage Outside New Jersey
- ID Protection ServicesID 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
- Horizon Get Care FAQsHorizon Get Care FAQs
- 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 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 SNP) FormsHorizon NJ TotalCare (HMO 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
-
Focus on HealthFocus on Health
- Focus on Health
- Focus on Health Fall 2018Focus on Health Fall 2018
- A closer look at how The Horizon Foundation makes a difference for people and communitiesA closer look at how The Horizon Foundation makes a difference for people and communities
- A healthy you takes twoA healthy you takes two
- Access standards help you get the care you need when you need itAccess standards help you get the care you need when you need it
- Access to quality careAccess to quality care
- Accessing home health servicesAccessing home health services
- All you need to know about Durable Medical EquipmentAll you need to know about Durable Medical Equipment
- Are you up to date on your cancer screenings?Are you up to date on your cancer screenings?
- Coverage decisionsCoverage decisions
- Does your doctor fit your needs?Does your doctor fit your needs?
- Effective careEffective care
- Find participating doctors and hospitals in and outside of New JerseyFind participating doctors and hospitals in and outside of New Jersey
- Learn how you can become a donorLearn how you can become a donor
- Learn more about your pharmacy benefitsLearn more about your pharmacy benefits
- Living with a chronic illness and depressionLiving with a chronic illness and depression
- Lower your out-of-pocket expenses by staying in networkLower your out-of-pocket expenses by staying in network
- Medical policies and prior authorizationsMedical policies and prior authorizations
- Referrals help your doctor manage your careReferrals help your doctor manage your care
- Researching new technology and treatmentsResearching new technology and treatments
- Six questions to ask when your doctor orders testsSix questions to ask when your doctor orders tests
- Surgical and Implantable Device Management Program to be ImplementedSurgical and Implantable Device Management Program to be Implemented
- Take control of your diabetesTake control of your diabetes
- Urgent care centers: an alternative to the Emergency RoomUrgent care centers: an alternative to the Emergency Room
- FIND A DOCTOR
- MEMBER SIGN IN
- SHOP FOR A PLAN
- Gaining a better understanding of ProstheticsGaining a better understanding of Prosthetics
- Making a PaymentMaking a Payment
- 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
- Understanding Your CostsUnderstanding Your Costs
- 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
- Navigating the Health NetworkNavigating the Health Network
- Out-of-Network PaymentsOut-of-Network Payments
- 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
- 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 Your Member ID CardUnderstanding Your Member ID Card
- Understanding the ExchangeUnderstanding the Exchange
- Who to Contact When You Have a QuestionWho to Contact When You Have a Question
- 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
- Transforming Health Care in New JerseyTransforming Health Care in New Jersey
- 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
-
Preventive HealthPreventive Health
- Preventive Health
- Preventive Health GuidelinesPreventive Health Guidelines
- Preventive Health Guidelines: Birth to age 21 yearsPreventive Health Guidelines: Birth to age 21 years
- Preventive Health Guidelines: AdultsPreventive Health Guidelines: Adults
- 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
Are you sure you want to leave this website?
You are leaving the Horizon Blue Cross Blue Shield of New Jersey website. Please click Continue to leave this website. Or, if you would like to remain in the current site, click Cancel.