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1199 coordination of benefits form for child

1199 coordination of benefits form for child-2025

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The document is a Coordination of Benefits Form for Young Adult Coverage provided by 1199SEIU Benefit Funds. It outlines the process for members to request health insurance coverage for their dependent children aged 19 to 26. The form requires detailed information about the member and the young adult, including eligibility for other health insurance plans through parents, employers, or spouses. It emphasizes the importance of accurate information and authorizes the Fund to access necessary medical records.

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Click ‘Get Form’ to open the 1199 coordination of benefits form in the editor.
Begin by filling in the Member’s Information section. Clearly print your full name, Member ID, and Benefit Fund details. Ensure your address, phone numbers, and email are accurate.
Next, provide the Young Adult’s Information. Enter your dependent's full name, Social Security number (last four digits), sex, and contact details if different from yours.
Indicate if your young adult can receive health insurance through another source. Fill out all applicable sections regarding other parent’s health plan, employer health plan, or spousal health plan.
For each section filled out, check the types of coverage available and provide effective dates along with insurance plan details.
Finally, review all information for accuracy before signing at the bottom of the form. Your signature certifies that all information is true and complete.

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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 do you mean by coordination of benefits?

Coordination of Benefits is a provision that determines the sequencing of coverage when Plan members and their dependents are eligible for benefits under more than one private health care plan. The PSHCP uses the benefit coordination guidelines established by the Canadian Life and Health Insurance Association (CLHIA).

Who is eligible for 1199 local benefit fund?

Members are generally eligible for benefits after they have been working for a contributing employer for 180 days or more, in most cases, except for Genesis and Actors Fund employees, who become eligible after 90 days. If you have questions about your eligibility, call the Fund at (646) 473-9200.

What is 1199?

1199SEIU United Healthcare Workers East is a healthcare union in the United States, with a membership of 400,000, including retirees. It is a local union within the Service Employees International Union.

What is a coordination of benefits form for?

Coordination of benefits (COB) allows plans that provide health and/or prescription coverage for a person with Medicare to determine their respective payment responsibilities (i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an

How does the cob work?

The coordination of benefits (COB) process determines the order in which multiple insurance providers are billed, effectively preventing duplicate payments and reducing the overall cost of healthcare for patients.

What is a coordination of benefits form?

Coordination of benefits (COB) is part of the insurance payment process. It is how insurance companies decide who covers the cost of your care in a given situation. Insurance companies follow general principles to establish the order each company will pay.

How do I contact 1199 National Benefit Fund?

The Benefit Funds have many self-service options to support you. To check 1199SEIU patient eligibility or benefit and claim status information, visit the NaviNet provider portal or call the Interactive Voice Response (IVR) System at (888) 819-1199 for 24-hour automated claims and eligibility service.

1199 coordination of benefits form for child-2025

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