Coordination of Benefits Form

Annual Coordination of Benefits (COB) Process

All members are required to complete the COB process when they enroll for the first time and in January each year.  There are three ways to complete the process:  

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  • 1.       Update your information on the website of our third-party administrator, Mutual Health Services (MHS). Or access the MHS site via the HRConnect Portal on the Intranet and avoid having to create a user ID and password.
  • 2.       Complete the hard copy COB form and submit it to MHSYou can download a form by clicking on the image below.
  • 3.       If you do not have other insurance now or at any time in 2011, you can update your COB information by calling MHS Customer Service at 1.800.451.7929. The automated phone system is available 24/7. Customer service representatives are available to assist you Monday-Friday, 8 a.m.-5 p.m.Eastern Time.

     

2012 Coordination of Benefits (COB) Form  Click on the image below.

Coordination of Benefits (COB) is the procedure used to pay healthcare expenses when you or an eligible dependent is covered by more than one health plan. The COB procedure follows the rules established by the laws of the state of Ohio.


View and/or print the 2012 Coordination of Benefits form by clicking here

 

View and/or print the 2011 Coordination of Benefits form by clicking here


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