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IBEX LOCAL 94 WELFARE FUND
COORDINATION OF BENEFITS FORM
PRINT ALL INFORMATIONParticipant Last Nonparticipant First Name. I. Social Security Cumbersome Address:
CityStateZip telephone #Please check
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How to fill out spouse coordination of benefits
How to fill out spouse coordination of benefits
01
Obtain the spouse's insurance information including the insurance company name, policy number, group number, and contact information.
02
Contact the spouse's insurance company to request a coordination of benefits form.
03
Fill out the coordination of benefits form accurately, including your insurance information and the spouse's insurance information.
04
Submit the completed form to the spouse's insurance company for processing.
Who needs spouse coordination of benefits?
01
Anyone who is covered by both their own insurance and their spouse's insurance may need to fill out a spouse coordination of benefits form.
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What is spouse coordination of benefits?
Spouse coordination of benefits is a process where the health insurance plans of a married couple work together to determine which plan will pay primary and which will pay secondary for a specific medical claim.
Who is required to file spouse coordination of benefits?
Married individuals with health insurance coverage are required to file spouse coordination of benefits.
How to fill out spouse coordination of benefits?
To fill out spouse coordination of benefits, individuals need to provide information about both spouses' health insurance coverage, including policy numbers, insurance company names, and coverage start dates.
What is the purpose of spouse coordination of benefits?
The purpose of spouse coordination of benefits is to avoid overpayment by the insurance companies and ensure that medical claims are processed correctly.
What information must be reported on spouse coordination of benefits?
Information such as policy numbers, insurance company names, coverage start dates, and any other relevant details about the health insurance coverage of both spouses must be reported on spouse coordination of benefits.
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