Horizon Claim Form - Fill Out and Sign Printable PDF TemplateDocHub 2026

1. Click ‘Get Form’ to open the Horizon Claim Form in the editor.
2. Begin by filling out the Insured’s Information section. Enter your last name, first name, date of birth, sex, identification number, address, telephone number, employer’s name, and insurance plan name.
3. If the patient is different from the insured, complete the Patient’s Information section with similar details including relationship to insured and patient status.
4. In the Other Insurance Information section, provide details if there is another insurance plan. Include policy holder's information as required.
5. Review all fields for accuracy. Ensure that itemized bills are attached and contain all necessary information as outlined in the form instructions.
6. Sign and date the form in the Authorization section. If applicable, complete the Assignment of Benefits section to direct payment to your healthcare provider.
7. Once completed, save your form using 'File > Save As' to keep a copy for your records before submitting it as instructed.

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