HORIZON MEDICARE PLAN DOCUMENT REQUEST

Evidence of Coverage, Formulary, Provider and Pharmacy Directory

Now, you have three simple ways to get information you need to take care of your health.
Call 1-800-365-2223 (TTY 711)
Visit HorizonBlue.com/Medicare
Request these documents for free using the simple request form below.
Fields marked with an asterisk (*) are required.
First Name
Last Name
Address 1
Address 2
City
State
Zip
Email
County
Member ID

Please send me the following item(s):

Select Language
Select Plan

Opt in to receive documents requested yearly



Horizon Blue Cross Blue Shield of New Jersey is an independent licensee of the Blue Cross Blue Shield Association. The Blue Cross® and Blue Shield® names and symbols are registered marks of the Blue Cross Blue Shield Association. The Horizon® name and symbols are registered marks of Horizon Blue Cross Blue Shield of New Jersey. © 2021 Horizon Blue Cross Blue Shield of New Jersey. Three Penn Plaza East, Newark, New Jersey 07105.

Legal Notice | Privacy Policy | Notice of Non Discrimination Y0090_DRFORM_2022_C

Last updated: 10/03/2022