BENEFIT INNOVATIONS, LLP
The COB form is required to determine whether you have other health coverage through another plan, such as a spouse’s insurance, Medicare, or any other health plan. With this information, PBA can avoid delays in processing your claims and prevent duplicate payments for the same services.
This form is required to process your claims. Even if you don’t have claims currently, you should submit the form now to avoid delays on any future claims you may have.
You can return the completed and signed form via mail, fax, or email, as follows.
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MAIL: PBA, PO Box 4687, Oak Brook, IL 60522-4687
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FAX: 630-286-4677
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EMAIL: amberb@benefiti.com
If you have questions, please contact PBA's Member Advocacy team at 800-435-5694 or call Benefit Innovations at 317-663-4044.