Horizon BCBS - Employee Benefits

ON-LINE RESOURCES

Provider Directory

Member Portal

Prescription Resources

FORMS LIBRARY

Employer Forms

Small Employer Application

Small Employer Certification

Product Conversion Form

2 - 5 Eligibility Form

Husband / Wife Verification

Automatic Debit Form

Employee Forms

Employee Enrollment/Change Form

Waiver

Medical Claim form

CVS / Caremark Mail Order RX

Preferred Drug List

Individual Application

Medigap Application

Dental

Dental Employer Application

Dental Employee Enrollment

Dental Companion Brochure

PPO Access Fee schedule

Dental Claim form