Please complete the Coordination of Benefits Information form and send to ASEBP as soon as possible if:
Examples of changes that ASEBP needs to be made aware of are termination of other coverage, changes in type of coverage, change of insurance provider etc.
Keeping ASEBP up-to-date helps to avoid any potential delays in claim payment and ensures you have accessed all possible sources of payment for your claims.
Note: The ASEBP covered member is the only person who is eligible to sign this form. If you have any questions regarding this form, please contact a Benefit Specialist.