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What Is Necessary On ‘Other Insurance’ Form?

Question: I received a form from my insurance company requesting information on what other insurance I have. How do I fill out this form?

Answer: The form you received is probably a Coordination of Benefits (COB) form. This is how the insurance companies keep track of who pays first and who pays second. This is the time of year when these forms come from your new insurance companies, and we have gotten a lot of these types of calls lately. Many of us make changes to our insurance situation over the years. When we make those changes, the new company usually wants to make sure they have your information accurate and complete.

Today I will be speaking to the Prescription Drug Coverage portion of your insurance.

I will use an example; you have had coverage through a Medicare Advantage Plan for some time, but this year (2023) you changed to a new company and a different plan. (But this information applies to almost all situations where you get one of these letters.)

Your new plan sent a letter indicating they believe you have Prescription Drug Coverage in addition to the coverage they are offering you or that you had a gap in your history of coverage. This COB form you received in the mail is the insurance company’s way of being sure what your history of Prescription Drug Coverage was, and what you have in addition to the plan they are offering you.

The Medicare Prescription Drug rules require you have creditable coverage since eligible for Medicare (usually turning 65). Sometimes individuals are still working or covered through a spouses insurance and don’t enroll in Medicare until later. This COB form may be asking about that period of employer coverage.

The second common coverage question is likely related to being enrolled in EPIC (Elderly Pharmaceutical Insurance Coverage Program) offered by New York State. EPIC is available to those individuals who live in New York, are over 65 and have annual income of up to $75,000 for a single person or $100,000 for married individuals. EPIC is always secondary to any other prescription drug coverage you may have. EPIC is not considered Creditable Drug Coverage and cannot replace your current drug coverage.

Your new insurance noticed that as you filled medications at the pharmacy it was run through their plan and also another plan. Your new company wants to be sure the claims are being processed in the correct order, ‘who pays first’?

Those COB forms are the insurance industries way of keeping all the claims and payment for claims accurately processed.

If you receive forms to complete and you don’t understand them or don’t understand why you have to complete them, call the company that sent them and ask what they are and why you have to complete them. Sometimes the questions can be addressed and corrected by talking with the staff on the phone.

The form will indicate their question; whether the gap in coverage or that you have additional drug coverage. They may list that coverage as EPIC, and they may list it as a SPAP (State Pharmacy Assistance Program). EPIC is classified as a SPAP, so the answer is the same. It may indicate that if this information is correct you don’t have to do anything. It also may indicate that you need to respond by checking off the appropriate box for the coverage you have had and what you currently have. Follow the directions in the letter and then mail back if necessary. (Sometimes the letters say, “If this information is correct you don’t need to do anything”.)

Please remember that once you have these forms completed, you should always make a copy to keep for your records, so you have proof that you did it and what you told them.

These forms do seem like a hassle, but it is better to fill them out, than later having the company decide they shouldn’t have paid the claim and come back at you to reimburse them for the payments they made.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call us at 716-720-9797 or e-mail at SLM@lutheran-jamestown.org .

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