Get Secondary Coverage Form (cob) - Selecthealth - Selecthealth

Completing the Secondary Coverage Form is essential for users who have multiple insurance plans. This guide provides clear, step-by-step instructions on filling out the form online to ensure proper coordination of benefits and avoid unnecessary claims delays.

Follow the steps to complete the Secondary Coverage Form effectively.

1. Press the ‘Get Form’ button to access the Secondary Coverage Form and open it for editing.
2. Begin by selecting if you are a new enrollee or an existing member with SelectHealth. Mark the appropriate box provided.
3. Fill in your personal details including your name, employer, street address, city, state, ZIP code, home phone number, and work phone number in the designated fields.
4. Indicate whether you or any of your covered dependents have other medical or dental coverage in addition to SelectHealth by checking 'Yes' or 'No'. If 'Yes', complete the form for each family member who has other coverage.
5. If applicable, attach copies of court documents if you are divorced or never married and have children needing coverage. Ensure that the required sections of your documents are included.
6. Provide details about your other insurance coverage. This includes the name of the other carrier, the type of coverage (medical or dental), the insurance policy number, and the relationship to the policyholder.
7. Review all information for accuracy. Make any necessary corrections before finalizing the document.
8. Once completed, save any changes made, download the form, and prepare to print or share as needed. Ensure to send the form to the provided address or fax number.

Complete your Secondary Coverage Form online today to ensure your benefits are correctly coordinated.