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 member experience team at 800-826-0940, Monday-Friday from 8 a.m. to 5 p.m. State of Wisconsin employees can call 844-625-2208, Monday-Friday from 8 a.m. to 4:30 p.m.