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FORM 16B
MICROENTERPRISE BUSINESS PROJECT SUMMARY FORM
Section I CBG Recipient Information
Recipient Name
CBG #
Ulster County
1160CVSB721
Duplication of Benefits (CDBCO Projects ONLY) Has the DOB
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How to fill out duplication of benefits
How to fill out duplication of benefits
01
Gather all necessary documentation related to the primary insurance plan.
02
Submit a claim to the primary insurance plan first.
03
Once you receive the Explanation of Benefits (EOB) from the primary insurer, review it carefully.
04
Fill out the duplication of benefits form provided by the secondary insurer.
05
Attach a copy of the primary insurer's EOB along with any additional required documentation.
06
Submit the duplication of benefits form to the secondary insurer for processing.
Who needs duplication of benefits?
01
Individuals who have multiple insurance plans covering the same expenses.
02
Healthcare providers who need to coordinate benefits between different insurance carriers for their patients.
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What is duplication of benefits?
Duplication of benefits occurs when a person receives assistance from multiple sources for the same purpose, leading to an excess of benefits.
Who is required to file duplication of benefits?
Individuals or organizations who receive assistance from multiple sources are required to file duplication of benefits.
How to fill out duplication of benefits?
Duplication of benefits forms can be filled out by providing detailed information about the assistance received from different sources.
What is the purpose of duplication of benefits?
The purpose of duplication of benefits is to prevent individuals from receiving more assistance than needed and avoid waste of resources.
What information must be reported on duplication of benefits?
Information such as the sources of assistance, amount received, and purpose of the assistance must be reported on duplication of benefits.
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