Get Co Operators Group Benefits Claim Forms

Navigating the Co Operators Group Benefits Claim Forms can seem daunting, but this guide is here to help you complete the process with confidence and ease. By following these comprehensive steps, you will successfully fill out and submit your claim online.

Follow the steps to complete your claim form online.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin with Part 1, the Employee/Member Statement. Fill in the Group Policy Number, Account Number, and your personal details including Last Name, First Name, and Patient Name. Provide your mailing address, date of birth, and relationship to the patient.
3. Indicate if you or your dependent have any other insurance coverage that would help pay for this claim. If so, provide the source of that coverage.
4. Complete sections regarding student status if applicable, including the name of the school, semester dates, and whether the student is full-time or part-time. Answer additional questions regarding the Health Spending Account.
5. Once you have filled out all necessary information in Part 1, ensure you sign and date the form, certifying that the information is true and complete.
6. Proceed to Part 2, the Supplier Statement, and ensure your Ophthalmologist, Optometrist, or Optician completes this section. Include details about visual defects and items supplied such as frames or lenses.
7. In the Supplier Statement, provide detailed charges for materials supplied including costs for frames, lenses, and any additional services. The supplier must sign and date this section.
8. If required, have the Employer/Policyholder section completed by an official with the necessary authorization, including effective and termination dates.
9. Review the entire form for accuracy, save your changes, and ensure you keep a copy of all receipts and documents for your records.
10. Finally, download or print the completed form, then submit it as per the instructions provided by Co Operators.

Start your claim submission process by filling out the document online today!