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Plumbers and Steamfitters Local 486 Medical Fund 911 Ridge brook Road Sparks, Maryland 211529451 Toll Free Telephone (888) 4944443 www.associatedadmin.com Coordination of Benefits Questionnaire Dear

How to fill out coordination of benefits and

How to Fill Out Coordination of Benefits:

1. Start by obtaining a copy of the coordination of benefits form from your primary health insurance provider. This form is typically available on their website or can be requested from their customer service department.
2. Carefully read through the instructions provided with the form to understand the required information and any specific guidelines for completing it.
3. Begin by entering your personal information in the designated sections of the form, including your name, address, phone number, and social security number or member ID.
4. Next, provide details about your primary health insurance coverage. This includes the name of the insurance company, policy number, and contact information for their claims department.
5. If you have any other health insurance coverage, such as through a spouse or parent's plan, provide the necessary information for the secondary insurance as well. This typically includes the name of the insurance company, policy number, and contact information.
6. Indicate the order of coverage by identifying which insurance is primary and which is secondary. Primary insurance is typically based on factors such as employment, age, or relationship to the insured individual.
7. If you have dependents covered under both primary and secondary insurance plans, provide their information separately in the designated sections of the form.
8. Review the completed form for accuracy and ensure that all required sections have been filled out. Double-check that your contact information is correct and legible.
9. Sign and date the coordination of benefits form, certifying that the information provided is accurate to the best of your knowledge.
10. Submit the completed form to the primary health insurance provider as instructed, either by mailing it to the claims department or submitting it online through their website.

Who Needs Coordination of Benefits:

1. Individuals who have multiple health insurance plans may need coordination of benefits. This could include individuals who have coverage through their own employer as well as through a spouse's employer, or individuals who have primary insurance through Medicare and secondary insurance through a private insurer.
2. Coordination of benefits ensures that claims are processed correctly and that the appropriate payment responsibility is determined between the multiple insurance providers.
3. It is important to coordinate benefits to avoid any potential overpayments or confusion when submitting claims for healthcare services or expenses. This process helps streamline the payment process and determines the correct order in which insurance companies should pay claims.

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What is coordination of benefits?

Coordination of benefits is a process where two or more insurance companies work together to determine their respective liabilities.

Who is required to file coordination of benefits?

The policyholder or the individual covered by multiple insurance plans is required to file coordination of benefits.

How to fill out coordination of benefits?

Coordination of benefits can be filled out by providing all insurance information, including policy numbers, coverage details, and any other relevant information to the insurance company.

What is the purpose of coordination of benefits?

The purpose of coordination of benefits is to ensure that the total amount paid by insurance companies does not exceed the actual cost of the claim, preventing overpayment.

What information must be reported on coordination of benefits?

Information such as policy numbers, coverage details, insurance companies' contact information, and any other relevant details must be reported on coordination of benefits.