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COB Questionnaire Form

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The document is a questionnaire for employees to provide annual insurance information required by the Group Health Insurance Plan's Coordination of Benefits (COB) provision. It requests details about the employee's spouse, Medicare eligibility, financial responsibility for dependents, and coverage for adult dependent children. Failure to submit this information may result in denied claims. The document includes instructions for submission via mail, fax, or email.

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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 COB questionnaire?

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 the difference between MSP and COB?

The Medicare Secondary Payer (MSP) program is in place to ensure that Medicare is aware of situations where it should not be the primary, or first, payer of claims. If a beneficiary has Medicare and other health insurance, Coordination of Benefits (COB) rules decide which entity pays first.

How does Cob work in healthcare?

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.

What is a cob request?

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

Do I need to fill out coordination of benefits?

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 is an example of 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.

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