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Home :  Members :  Forms and Newsletters :  Downloadable Forms
Downloadable Forms
As a service to our members, we are making the most commonly requested forms available for download. The documents are available in an Adobe® Acrobat® portable document format (PDF). Simply click on the title of the form you wish to download.Get Acrobat Reader
Claim Forms | Pharmacy Forms | FSA & HSA Plan Forms |Privacy Forms (HIPAA| Dental Forms | Misc. Forms | Individual Subscriber Forms |
Claim Forms
DownloadMedical Claim Form - HMO / POS / Direct Access (0834)
DownloadMedical Claim Form - PPO & Traditional (7190)
DownloadMedical Claim Form - NJ Plus (0737)
DownloadMedical Claim Form - SHBP Traditional (0704)
DownloadMedical Claim Form - SHBP NJ DIRECT (2642)
DownloadDental Claim Form (7902)
DownloadHorizon MyWay HRA Claim Form (2816)
Pharmacy Forms
DownloadPrescription Claim Form (14694)
DownloadPrescription Mail Order Form (13598)
DownloadPrescription Mail Order Form - Spanish (15753)
DownloadFormulary Exception Form (6592)
FSA & HSA Plan Forms
DownloadFSA Claim Form (6518)
Privacy Forms (HIPAA)
DownloadAuthorization for Disclosure of Protected Health Information (3566)
DownloadTransfer of Medical Records (7953)
DownloadRequest for Personal Representative Form  
DownloadRequest to Terminate Personal Representative Form 
Dental Forms
DownloadHorizon Centurion Dental Enrollment Form (9236) 
DownloadHorizon Individual Dental Enrollment Form (9280) 
DownloadDental Deductible Carryover Credit Report for NJ (7263)
DownloadDentist Recruiting Request Form for NJ (9652)
DownloadEmployee Dental Application for Enrollment or Change for NJ (4555)
DownloadAuthorization for Disclosure of Protected Health Information (5418)
Misc. Forms
 
DownloadIndividual Direct Access Member Handbook
Individual Subscriber Forms

DownloadConsumer/Individual Automatic Pay Plan Application (2782)
DownloadEnrollment Application (0744)
DownloadIndividual Plan Descriptions 

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