Forms & Documents

Claim Forms

HOME > Claim Forms

To download a file right click on the "Download File" link and select either "Save Link As..." or "Save Target As...".

Horizon PPO/Traditional Claim Form

Last Updated: Oct 6, 2015

Prime Rx Mail Order Claim Form

Last Updated: Oct 6, 2015

Prime Rx Reimbursement Claim Form

Last Updated: Apr 10, 2017