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Coordination of benefits letter

Coordination benefits form 2025

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The document is a Coordination of Benefits Questionnaire from Blue Cross Blue Shield of Michigan, designed for enrollees to provide information about their health coverage. It includes sections for the enrollee's details, information about any additional group health coverage, and special situations regarding children's coverage due to divorce or separation. The form must be completed and returned to update coordination of benefits.

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Click ‘Get Form’ to open the coordination benefits form in the editor.
Begin with SECTION 1, where you will enter your BCBSM enrollee name and ID number as found on your ID card. If you or any dependents have additional coverage, select 'YES' and proceed to complete the entire form.
In SECTION 2, provide details about the policy holder of any other health coverage. This includes their name, relationship to you, social security number, employer information, and insurance company details. Be sure to check all applicable boxes regarding coverage type.
If applicable, fill out SECTION 3 for special situations involving children’s health care coverage due to divorce or separation. Include necessary details such as court orders and responsible parties.
Finally, sign at the bottom of the form and return it via mail or fax as indicated.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is an example of coordination of benefits?

The accompanying coordination of benefits (COB) questionnaire contains questions about other forms of insurance you may have. Having up-to-date COB information enables your employers benefit plan to save money by avoiding duplicate payments or overpayment.

What is a coordination of benefits form?

Yes. Insurance companies may refuse to pay claims until receiving verification of health coverage. Insurance companies regularly check coordination of benefit status. They may require it even when there is no other insurance coverage to coordinate.

What happens if coordination of benefits is not updated?

If the coordination of benefits status is not updated, it is possible your insurance company will refuse to pay any claims. They may identify the amount owed as patient responsibility, leaving you with the full balance for your visit(s).

Should I do coordination of benefits?

Getting coordination of benefits is set up will prevent billing headaches later on. Do I still need to do this if I only have one health insurance plan? Yes. Insurance companies may refuse to pay claims until receiving verification of health coverage.

Is it worth it to have two health insurance plans?

More savings: Multiple plans can offset more costs, increasing your savings when receiving healthcare. For example, your primary insurance might only cover 80% of a specific procedure. If your secondary insurance covers the rest, you bear no cost.

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Do I need to fill out coordination of benefits?

For example, suppose you visit your doctor and get billed $250 for the appointment. Your primary health plan may cover the majority of the bill. Lets say, for example, thats $200. Then your secondary plan would pay the remaining $50.

What triggers a coordination of benefits?

Common reasons for the coordination of benefits to be requested by insurance are: When an individual is covered by their employers policy and is also covered under their spouses plan. When an individual has a private or marketplace plan and has an additional plan through a spouse or parent.