Dental Claim Form
Use this form to file a Horizon Dental plan claim or to request an up-to-date report of a member's dental benefits so they can plan for future dental expenses.
ID: 7902 (W0113)
Dental Recruiting Request Form
To invite your dentist to join one or more of our dental networks, present them with this Recruiting Request Form. If your dentist is interested in joining, they can mail this form to us for consideration. If your dentist meets ourrequirements and becomes a participating dentist, you will be eligible to receive the highest level of benefits from your dental program when you use this dentist.
Request for Continuance of Enrollment for a Disabled Dependent
ID: 9429 (W0718)