Coordination of Benefits
Coordination of Benefits - Active - Police and Fire
Marriage Certification Divorce Certification Coordination of Benefits - Retirees - 1033, Police, Fire (pdf37)Coordination of Benefits Documentation
Supportive Documentation:
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Coverage effective date (Example: letter from employer or pay stub showing initial deduction with effective date)
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Cost - Either annual, monthly or per paycheck. If per paycheck, you must provide two consecutive pay stubs. IF YOU ARE A TEACHER, you must provide the annual amount and paycheck frequency i.e. 21 weeks, 26 weeks, 10-month, etc.
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Proof of Insurance - Example: a copy of insurance card or communication from the employer confirming ID#, other family member(s) covered, if applicable, group name, policy holder
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Proof of Individual Coverage - This may be found on the new insurance card, or check stub or you may provide a letter from the employer confirming individual coverage
NOTE: A letter from your employer providing clarification on any of the above is sufficient if the insurance card or check stubs do not include all of the required information.