Medical Forms

 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-12-42

 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 - National Accounts

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

 Claim Form - PPO / Traditional

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

 Claim Form - Reimbursement - Orally Administered Cancer Medication Coverage

Use this form to request reimbursement for cancer medication. ID: 5337

 List - BlueCard Minute Clinics (National Accounts)

List of participating BlueCard® Minute Clinics.

 Request Form - Credit for Deductible Carryover

If new members (and/or covered family members) have met all or part of their deductible under a prior Medical plan, use this form to request that a credit be applied to their new plan. ID: 7239

 Request Form - Transition Care Benefit

Use this form to request Transition Care benefits. ID: 7164