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SHEET METAL WORKERS 4530 Roosevelt Road Hillside, IL 60162-2053 Phone 708-449-7373 Fax 708-449-7458 LOCAL UNION NO. 73 WELFARE FUND Coordination of Benefits Form 2010 Your insurance with Sheet Metal

How to fill out 2004 coordination of benefits

How to fill out 2004 coordination of benefits:

1. Begin by obtaining a copy of the 2004 coordination of benefits form from your health insurance provider. This form is typically used when you have multiple insurance plans that may cover the same expenses.
2. Start by providing your personal information, including your full name, address, date of birth, and social security number. These details will ensure accurate identification.
3. Next, indicate the primary insurance you have by providing the policy number and the name of the insurance provider. The primary insurance refers to the plan that pays their portion of the claim first.
4. If you have secondary insurance, fill out the section for the secondary insurance provider. Provide the policy number and the name of the insurance company as well.
5. Specify the type of coverage each insurance plan offers by checking off applicable boxes on the form. This may include options such as medical, dental, vision, prescription drugs, or others.
6. In the section for the primary insurance claims processing address, enter the complete address where claims should be sent to the primary insurance company. This information can typically be found on your insurance card or within your plan documents.
7. Similarly, provide the claims processing address for your secondary insurance company in the appropriate section. Again, this information can usually be found on your insurance card or within your plan documents.
8. Finally, sign and date the form to certify the accuracy of the information provided. Additionally, you may need to include any required supporting documents or authorizations as specified by your insurance provider.

Who needs 2004 coordination of benefits:

1. Individuals who have multiple insurance plans, such as dual coverage through their employer and a spouse's insurance, may need to complete a 2004 coordination of benefits form.
2. Individuals who have primary insurance coverage under one plan, but also have secondary insurance through another plan, will also need to complete this form.
3. It is important to complete the coordination of benefits form accurately and timely to ensure proper processing of insurance claims and prevent any delays or denial of coverage.

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What is coordination of benefits?

Coordination of benefits is a process that determines the primary and secondary health insurance coverage for a patient when they are covered by more than one insurance plan.

Who is required to file coordination of benefits?

Healthcare providers are typically required to file coordination of benefits to determine the correct order of payment between primary and secondary insurance plans.

How to fill out coordination of benefits?

Coordination of benefits is typically filled out by providing information about all insurance plans covering the patient, including policy numbers, coverage dates, and primary/secondary status.

What is the purpose of coordination of benefits?

The purpose of coordination of benefits is to ensure that the patient's healthcare costs are paid correctly by the primary and secondary insurance providers, avoiding overpayment or underpayment.

What information must be reported on coordination of benefits?

Information such as insurance policy numbers, coverage dates, types of coverage, primary/secondary status, and any other relevant insurance information must be reported on coordination of benefits forms.