Get Blue Care Network - Coordination Of Benefits Form - The Tmta

Filling out the Blue Care Network - Coordination Of Benefits Form - The TMTA is an essential process to ensure that your health care coverage is accurately managed. This guide provides step-by-step instructions to assist you in completing the form online with ease.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the subscriber's name at the top of the form. This identifies the individual who holds the insurance policy.
3. Fill in the BCN contract number, which can be found on your insurance documents, to link the form to your coverage.
4. Provide your current address including city, state, and zip code, so that your contact information is up to date.
5. Answer the question about whether you or any dependents have additional health, Medicare, or prescription coverage. Select ‘No’ if applicable, and proceed to sign and date the form. If ‘Yes,’ continue with the questionnaire.
6. If there are court-ordered health care responsibilities, indicate that documentation must be enclosed, and list the relevant details as required.
7. Complete the sections regarding other health coverage, including the policy holder's name, social security number, relationship to the BCN subscriber, employer's name, and contact information.
8. Specify whether the policy is active or retiree, and provide necessary details such as the date retired, effective date, and termination date, if applicable.
9. List all Blue Care Network members covered under this plan, detailing their names and their relationship to the subscriber.
10. Repeat the previous two steps for any additional health or prescription coverage that may apply.
11. Review all provided information for accuracy and completeness before signing the form to confirm that all statements are true and accurate.
12. Finally, ensure to provide your phone number and the date of submission before saving your changes, and downloading, printing, or sharing the completed form as needed.

Take the next step and complete your documents online for effective health coverage management.