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  • Secondary Coverage Form (cob) - Selecthealth - Selecthealth

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P.O. Box 30192 Salt Lake City, UT 84130-0192 801-442-5038/800-538-5038 selecthealth.org Secondary Coverage Form (COB) Coordination of Benefits (COB) rules apply when you or any of your covered dependents.

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Select Health administers a managed Medicaid plan, Select Health Community Care, that is available to eligible members living in all Utah counties. Utah's Medicaid program is designed to provide valuable medical coverage for Utah residents with limited incomes and/or resources.

SelectHealth Provider Networks The Value network is best for those looking for a mid-sized network for less money. The Signature network is best for those looking for small network for even less money.

Our traditional Individual and Family plans—also called Affordable Care Act (ACA) plans—offer comprehensive coverage for your medical and prescription needs.

Select Health (Medicare & Medicaid Plans) Claims must be filed within 12 months from the date of service.

In a reimbursement claim, you must settle your medical bills with the hospital and subsequently file a reimbursement claim with your insurance provider. You can choose any hospital for your medical procedure, get the treatment done, settle the bills from your pocket, and then file for reimbursement.

SUBMIT ONLINE FOR FASTER REIMBURSEMENT: > Visit selecthealth.org/medicare, click “Wellness Resources,” then “Wellness Reimbursement.” > Fill out the web form, then scan and upload your receipt or proof of payment. > Click “Online Wellness Reimbursement Form.”

Submit claims to us via: P.O. Box 30192 SLC, UT 84130 (for Commercial/Medicaid/CHIP) P.O. Box 30196 SLC, UT 84130 (for Medicare claims ONLY)

There are four ways to get this form: Log in to your Select Health account and download your 1095-B under "Documents" Send an email to premiums@selecthealth.org to request your 1095-B. ... Call our Billing team at 844-442-4106 to request your 1095-B. Mail a request for your 1095-B to:

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232