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. Once you've completed the form, mail it to the address on the form. Network Health will communicate with the other health insurance company to determine which company pays for each claim.

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. 

Coordination of Benefits (COB) Form

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.