Coordination of Benefits (COB) Verification Form
If you are covered by more than one health insurance plan, please complete this form to help ensure that your future health insurance claims are processed correctly. COB determines which plan is responsible for paying a claim first (primary) and which plan is responsible for paying a claim second (secondary).
Print this form, complete and send to:
Physicians Plus Insurance Corporation
P.O. Box 269001
Plano, TX 75026-9001
Dental Provider Selection Form
Print this form, complete and send to:
Dental Enrollment Department
C/O SVA Consulting
PO Box 44966
Madison, WI 53744-4966
Disclosure Authorization Form
Transition of Care Form
Please fill out the form and fax, E-mail, or mail to the number/address on the form.
Wisconsin Advance Directive
