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Coordination of Benefits

Coordination of Benefits Form

Fill out this form if you and other members of your household are covered by more than one health insurance plan. Network Health will communicate with the other health insurance company to determine which company pays for each claim.

You may complete the form online or you may print the Coordination of Benefits (COB) Form. When complete, mail it to the address on the form.

If you have any questions, call our customer service department at 800-826-0940, Monday, Wednesday, Thursday and Friday from 8 a.m. to 5 p.m. and Tuesday from 8 a.m. to 4 p.m. 


Network Health
1570 Midway Place
Menasha, WI 54952
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.