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The easiest way to submit out-of-network medical claims is through the Horizon Blue app. When you use the Horizon Blue app, you don’t need to submit a claim form by mail.

If you prefer to submit out-of-network medical claims by mail, you will need to include the appropriate claim form listed below and mail it, and the required information listed on the form, to the address on the form:

• Merck members: Merck Health Insurance Claim Form
• Organon members: Organon Health Insurance Claim Form
• State Health Benefit Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members: SHBP/SEHBP Medical Plan Claim Form
• All other members: Horizon Health Insurance Claim Form

1. Click Vision under Doctors & Care.
2. Follow the instructions on screen to be redirected to the appropriate vendor’s website, where you can locate information about submitting vision claims.

Complete the Dental Claim Form and mail it, and the required information listed on it, to the address on the form. You can submit out-of-network dental claims by mail only.

The easiest way to submit out-of-network mental health and SUD claims is through the Horizon Blue app. When you use the Horizon Blue app, you don’t need to submit a claim form by mail.

When you submit out-of-network mental health and SUD claims by mail, you will need to include the appropriate claim form listed below and mail it, and the required information listed on the form, to the address on the form:

• Merck members: Merck Health Insurance Claim Form
• Organon members: Organon Health Insurance Claim Form
• State Health Benefit Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members: SHBP/SEHBP Medical Plan Claim Form
• All other members: Horizon Health Insurance Claim Form

1. Under Doctors & Care, click Prescriptions.
2. If you see Go to Prime Therapeutics: Mail the Prescription Drug/COVID-19 At Home Test Kit Claim Form to the address on the form. If you do NOT see Go to Prime Therapeutics: Follow the instructions on screen to be redirected to the appropriate vendor’s website, where you can find information about submitting prescription claims.

Due to the end of the federal COVID-19 public health emergency, over-the-counter (OTC) tests for COVID-19 stopped being covered effective May 12, 2023. Please do not submit claims for OTC COVID-19 tests that were purchased on or after May 12, 2023 as we will not reimburse you for them.

However, if you purchased OTC COVID-19 tests out-of-pocket before May 12, 2023, you can still submit a pharmacy claim form for reimbursement for up to 12 months after the date of purchase. To access pharmacy claim forms, select Prescriptions, then Pharmacy Benefits¹ to go to your pharmacy’s website and access claim forms. Members with Prime Therapeutics as their pharmacy manager can also access the Prescription Drug Claim Form on Horizon’s website.

Medical and Behavioral Health Claims

When you submit out-of-network medical claims through your account using our website or the Horizon Blue app, you don’t need to submit a claim form by mail. Simply select Claims, then Submit a Claim.

To submit these claims by mail, please include the appropriate claim form below and mail it, and the required information listed on the form, to the address on the form:

• Merck members: Merck Health Insurance Claim Form
• Organon members: Organon Health Insurance Claim Form
• State Health Benefit Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members: SHBP/SEHBP Medical Plan Claim Form
• All other members: Horizon Health Insurance Claim Form

Prescription Claims

Select Prescriptions, then Pharmacy Benefits¹ to go to your pharmacy’s website, where you can find information about submitting prescription claims. Members with Prime Therapeutics as their pharmacy manager can mail the Prescription Drug Claim Form, and the required information listed on it, to the address on the form.

Dental Claims

Complete the Dental Claim Form and mail it, and the required information listed on it, to the address on the form.

Vision Claims

Select Get Care, then Vision. Follow the instructions on screen to be redirected to the appropriate vendor’s website, where you can find information about submitting vision claims.

When you submit out-of-network medical claims through your account using our website or the Horizon Blue app, you don’t need to submit a claim form by mail. Simply select Claims, then Submit a Claim.

If you prefer to submit out-of-network medical claims by mail, you will need to include the appropriate claim form listed below and mail it, and the required information listed on the form, to the address on the form:

• Merck members: Merck Health Insurance Claim Form
• Organon members: Organon Health Insurance Claim Form
• State Health Benefit Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members: SHBP/SEHBP Medical Plan Claim Form
• All other members: Horizon Health Insurance Claim Form

To access vision claim forms, select Get Care, then Vision. Follow the instructions on screen to be redirected to the appropriate vendor’s website, where you can locate information about submitting vision claims.

When you submit out-of-network mental health and substance use disorder (SUD) claims through your account using our website or the Horizon Blue app, you don’t need to submit a claim form by mail. Simply select Claims, then Submit a Claim.

When you submit out-of-network mental health and SUD claims by mail, you will need to include the appropriate claim form listed below and mail it, and the required information listed on the form, to the address on the form:

• Merck members: Merck Health Insurance Claim Form
• Organon members: Organon Health Insurance Claim Form
• State Health Benefit Program (SHBP) and School Employees’ Health Benefits Program (SEHBP) members: SHBP/SEHBP Medical Plan Claim Form
• All other members: Horizon Health Insurance Claim Form