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Writers Guild IndustryHealth Fund Coordination of Benefits Form Please submit this form with all supporting documentation to The Fund Mailing Address:, Burbank, CA 91505 or access this form on our

How to fill out coordination of benefits form

How to fill out a coordination of benefits form:

1. Start by obtaining a copy of the coordination of benefits form from your insurance provider. This form is typically required when you have multiple insurance coverages, such as when you have coverage through both your employer and your spouse's employer.
2. Read through the form carefully and ensure you understand the sections and information required. Generally, the form will ask for personal details, such as your name, address, and contact information.
3. Provide your primary insurance information. This includes details about your primary insurance provider, such as the name of the company, policy number, and group number. Make sure to accurately enter this information to avoid any issues with claims processing.
4. Indicate the coverage type of your primary insurance, such as health, dental, or vision. If you have multiple primary insurance coverages, you may need to fill out additional sections or provide separate forms for each coverage.
5. If you have secondary insurance, provide the details of your secondary insurance provider. This includes the name of the company, policy number, and group number, similar to what you provided for your primary insurance.
6. Indicate the coverage type of your secondary insurance. Again, if you have multiple secondary insurance coverages, you may need to fill out additional sections or provide separate forms for each coverage.
7. Review the completed form to ensure all information is accurate and legible. Check for any missing sections or errors before submitting the form to your insurance provider.
8. Keep a copy of the completed form for your records in case there are any discrepancies or future reference.

Who needs a coordination of benefits form:

1. Individuals who have multiple insurance coverages, such as having coverage through both their employer and their spouse's employer.
2. Those who have secondary insurance coverage, which is additional insurance coverage that supplements their primary insurance.
3. Individuals who want to ensure that their insurance claims are processed correctly and that their coverage is maximized to avoid unnecessary out-of-pocket costs.

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What is coordination of benefits form?

Coordination of benefits form is a form used in the health insurance industry to determine the primary payer when an individual is covered by more than one insurance plan.

Who is required to file coordination of benefits form?

The policyholder or the insured individual is required to file the coordination of benefits form.

How to fill out coordination of benefits form?

To fill out the coordination of benefits form, you will need to provide information about all insurance plans you are covered by, including policy numbers and coverage details.

What is the purpose of coordination of benefits form?

The purpose of the coordination of benefits form is to determine the order of payment when an individual is covered by more than one insurance plan.

What information must be reported on coordination of benefits form?

Information such as policy numbers, coverage details, and other insurance plans you are covered by must be reported on the coordination of benefits form.