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SHEET METAL WORKERS' LOCAL UNION NO. 73 WELFARE FUND 4530 Roosevelt Road Hillside, IL 60162-2053 Phone 708-449-7373 Fax 708-449-7458 Coordination of Benefits Form 2012 Your insurance with Sheet Metal

How to fill out 2004 coordination of benefits

How to fill out 2004 coordination of benefits:

1. Start by gathering all necessary information, including personal details, insurance policy numbers, and contact information for all parties involved.
2. Review the instructions and form carefully to ensure you understand the requirements and sections of the 2004 coordination of benefits form.
3. Begin filling out the form by providing your personal information, such as your name, address, and date of birth.
4. Next, fill in the details of your primary insurance coverage, including the policy number, coverage start and end dates, and the name of the insurance company.
5. If you have secondary insurance coverage, provide the necessary details in the corresponding section of the form.
6. Ensure that all information provided is accurate and up to date. Double-check for any errors or missing data.
7. Once you have completed filling out the form, review it thoroughly to verify the accuracy of the information provided.
8. Sign and date the form as required.
9. Keep a copy of the completed 2004 coordination of benefits form for your records.
10. Submit the form to the relevant parties, such as your insurance company or healthcare provider, as per their instructions.

Who needs 2004 coordination of benefits:

1. Individuals who have multiple insurance policies, such as primary and secondary coverage, may need to complete the 2004 coordination of benefits form.
2. Employers or benefit administrators who manage employee insurance plans may require the completion of this form to coordinate benefits accurately.
3. Healthcare providers or medical facilities may request the completion of the 2004 coordination of benefits form to ensure proper billing and coordination of payment between multiple insurance companies.

For pdfFiller’s FAQs

What is coordination of benefits?

Coordination of benefits is a process that ensures proper payment of health insurance claims in cases where a person has coverage under multiple insurance plans.

Who is required to file coordination of benefits?

The policyholder who has coverage under multiple insurance plans is required to file coordination of benefits.

How to fill out coordination of benefits?

To fill out coordination of benefits, the policyholder must provide details of all insurance coverage, including policy numbers, insurance company names, and effective dates.

What is the purpose of coordination of benefits?

The purpose of coordination of benefits is to determine the correct order in which multiple insurance plans should pay claims for a covered individual, avoiding overpayment or duplication of benefits.

What information must be reported on coordination of benefits?

The information that must be reported on coordination of benefits includes the policyholder's personal details, insurance coverage details, claims information, and any coordination of benefits agreements.

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