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AUTUMN TRUST FUND 2021 COORDINATION OF BENEFITS REQUEST FORM Date___ Name___ Address___ ___Badge #: ___ FT, PT or RT: ___ Anthem ID #: ___Each year the AUTUMN Trust Fund needs to obtain updated information
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How to fill out coordination of benefits request
How to fill out coordination of benefits request
01
Contact your insurance company to request a coordination of benefits form
02
Fill out all necessary information on the form, including your insurance policy details and the other insurance policy details
03
Submit the completed form to your insurance company for review and processing
Who needs coordination of benefits request?
01
Individuals who have multiple insurance policies and want to ensure that their claims are processed correctly
02
People who are covered by both their own insurance plan and a spouse's insurance plan
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What is coordination of benefits request?
Coordination of benefits request is a process by which insurance companies determine the primary payer when an individual is covered by more than one insurance plan.
Who is required to file coordination of benefits request?
The insured individual or their authorized representative is required to file a coordination of benefits request.
How to fill out coordination of benefits request?
To fill out a coordination of benefits request, the insured individual must provide information about all insurance plans they are covered under, including policy numbers, names of insurance companies, and coverage details.
What is the purpose of coordination of benefits request?
The purpose of coordination of benefits request is to ensure that medical expenses are paid correctly by the primary insurance plan before the secondary insurance plan is billed.
What information must be reported on coordination of benefits request?
The information that must be reported on a coordination of benefits request includes details of all insurance coverage, including policy numbers, names of insurance companies, and coverage details.
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