Provider Directory   |   About Us   |   Horizon Links   |   Site Map   |   Careers   |   Community Involvement
Horizon Blue Cross Blue Sheild of New JerseyMaking Healthcare WorkPhoto
Members Icon    Home     :     Horizon MyWaySM   
What is MyWay? Plan Choices and Features Member Services and Account Management Care Choices Contact and Help
Horizon MyWay
MyWay Help
 What is MyWay?
 Plan Choices and Features
 Member Services and Account Management  
    Member Services
    Personal Account Management
    Forms
 Care Choices
 Contact and Help
Search
Members / Member Services and Account Management / Forms
Image Spacer
Forms
Dotted Line
Image Spacer

As a service to our members, we make the most commonly requested forms available for download in an Adobe Acrobat portable document format (PDF).
 
~ Horizon MyWay HSA Forms
  Mellon HSA Employee Welcome Kit
This is an example, for illustrative purposes only, of the ACS/Mellon HSA Employee Welcome Kit. ACS/Mellon mails Welcome Kits to each employee as part of the Horizon MyWay HSA enrollment process. Prompt completion and return (to Mellon) of the Signature Card is required to establish an employee's HSA.		 Adobe Acrobat Download
  Enrollment Form for HSA Members with Chase Adobe Acrobat Download
  Disbursement Form for HSA Members with Chase
Use this form to document and submit HSA disbursements. This form may be printed out blank or completed on your computer and printed.		 Adobe Acrobat Download
 
~ Horizon MyWay FSA Forms
  FSA Claim Form
Note: Copies of bills, invoices, or other written statements from a third party that support each reimbursement request should be attached to this form.		 Adobe Acrobat Download
  FSA Eligible Expense List
This is a list of eligible health care expenses as defined by the IRS.		 Adobe Acrobat Download
 
~ Horizon MyWay HRA Forms
  HRA Claim Form
Note: Copies of bills, invoices, or other written statements from a third party that support each reimbursement request should be attached to this form.		 Adobe Acrobat Download

What is MyWay?Plan Choices and FeaturesMember Services and Account ManagementCare ChoicesContact and Help

Services and products may be provided through Horizon Blue Cross Blue Shield of New Jersey, an independent licensee of the Blue Cross and Blue Shield Association.
Legal Notice.

® Registered marks of the Blue Cross and Blue Shield Association.
®' Registered marks of Horizon Blue Cross Blue Shield of New Jersey.
SM Service mark of Horizon Blue Cross Blue Shield of New Jersey.