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THIS FORM CAN BE DOWNLOADED FROM OUR Website AT www.HorizonBlue.comHorizon POS Health Insurance Claim Form
Please Print This Form In Color (If Available).INSUREDS INFORMATION
FIRST NAME1. LAST NAME3.
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What is if yes complete?
If yes complete is a section of the form where you indicate if a certain condition or requirement has been met.
Who is required to file if yes complete?
The individual or entity who meets the conditions specified in the 'if yes complete' section is required to file.
How to fill out if yes complete?
You must carefully read the conditions or requirements listed in the 'if yes complete' section and mark 'yes' if they have been met.
What is the purpose of if yes complete?
The purpose of the 'if yes complete' section is to ensure that the necessary information is reported accurately and completely.
What information must be reported on if yes complete?
The information required to be reported on 'if yes complete' will depend on the specific conditions or requirements listed.
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