Get Coordination Of Benefits Form - Dgaplans.org - Dgaplans

Filling out the Coordination Of Benefits Form is essential for coordinating your claims with other health insurance plans. This guide provides clear, step-by-step instructions to help you navigate the form with ease.

Follow the steps to complete the Coordination Of Benefits Form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by reading the introductory section of the form, which outlines the purpose and necessity of submitting this form annually, even if you have no other health insurance.
3. In the section titled 'Other Health Insurance Coverage', answer the questions regarding whether you or any of your dependents are covered by another health insurance plan and provide details as applicable.
4. For each health insurance plan you or your dependents are covered by, fill in the required information including the type of plan, name of the insured, name of the insurance plan, plan phone number, policy number, and date the policy began.
5. If you have dependents covered under other plans, provide their relevant information where indicated.
6. If applicable, provide the name of the employer associated with group plans. Make sure to review all filled information for accuracy.
7. Finally, certify that the information provided is correct by signing and dating the form. Fill in your name, Health Plan ID number or Social Security number, and daytime phone number.
8. Once all sections are complete, you can save changes, download, print, or share the form as required.

Fill out your Coordination Of Benefits Form online now to ensure your health claims are accurately processed.