You'll get a personalized experience, guiding you step-by-step through the process. We will only ask you for information that relates to your situation.

Before you get started

You'll need:

  • Enrollee ID cards from all other plans.
  • Full name and birth date for each person covered by other insurance.
  • If you or someone on your account also has Medicare, you’ll need the Medicare card issued by the government.
  • If someone on your plan has other insurance because of a court order from the Friend of the Court or a divorce decree, you’ll need those legal documents.

Complete your Coordination of Benefits form online

  1. Only the subscriber can fill out the form
  2. Log in to your account at
  3. You'll be guided through the form
  4. When you fill out your form online, it'll prepopulate with the members on your contract, saving you time