AOB form definition

AOB form means the document or instrument that contains a provision by which the assignor
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AOB form means the document or instrument that contains a provision by which the assignor assigns medical expense benefits, including any assignment of the proceeds of such coverages, to an assignee. The AOB form may be a separate instrument or included in another instrument, including a consent form or a form assigning other benefits.
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Examples of AOB form in a sentence

  • All insured patients will be expected to sign an Assignment of Benefits (AOB) form and any other forms required by their insurance carrier or by regulation in order to bill and collect from their third-party insurer.

  • All insured patients will be required to sign an Assignment of Benefits (AOB) form, HIPPA notice and any other forms required by their insurance carrier or by regulation in order to bill and collect from their third party insurer.

  • Authorization for Treatment:Once you have met with and assessed your new client you must complete the Managed Care Assessment and Client Plan, and the Assignment of Benefits (AOB) form.

  • Mail the Assignment of Benefits (AOB) form to the Claims Department: 2000 Alameda de las Pulgas Suite 280, San Mateo, CA 94403.

  • All insured patients will be expected to sign an Assignment of Benefits (AOB) form and any other forms required by their insurancecarrier or by regulation in order to bill and collect from their third party insurer.

  • O’Neale signed her own AOB form on September 3, 2015, when Air Methods contacted her and asked her to sign it.Defendants claim that the identical financial responsibility provision contained in the A&C and AOB forms are important on the question of assent.

  • Following the incident Randal Cowen received the AOB form in the mail.

  • As for the AOB form, it is delivered to patients several weeks after the transport.Randall Cowen signed the AOB form on September 17, 2016.

  • One organization provided specific details indicating how that organization conducts analysis to determine the number of new employees needed.

  • All beneficiaries with an HMO plan are asked to sign an AOB form at the account set up, which allows us to bill the HMO payer(s) and to accept payment or other responses.

Related to AOB form

  • Opt-Out Form means the form through which Eligible Employees may note their decision to opt out of participation in the Program.

  • Enrollment Form means an agreement pursuant to which an Eligible Employee may elect to enroll in the Plan, to authorize a new level of payroll deductions, or to stop payroll deductions and withdraw from an Offering Period.

  • Application Form means any application form to be completed by subscribers for Shares as prescribed by the Company from time to time.

  • Letter of Transmittal and Election Form means the letter of transmittal and election form(s) to be delivered by Company to the Company Shareholders and Company RSU Holders and providing for the Company Shareholder’s and Company RSU Holders election with respect to the Consideration;

  • Bid Application Form means the form as specified in Annexure II of this E-Auction Process Information Document;

  • FACE Form means the Funding Authorization and Certificate of Expenditure Form attached to this Agreement. The FACE Form is used for (i) requests for cash advances, direct payments or reimbursements and (ii) financial reporting by the Partner.

  • Short Form Notice means the Short Form Notice substantially in the form as

  • Subscription Form means the form of subscription annexed hereto as Schedule “A”;

  • Authorization Form means a form specified in s. 440.73.

  • Election Form means the form established from time to time by the Committee that a Participant completes, signs and returns to the Committee to make an election under the Plan.

  • Bid Form means the bid form required to be submitted by an Interested Bidder, as per Annexure I;

  • Assignment Form means the assignment form attached as Annex 2 hereto.

  • Special Instruction Form means a standardized form prescribed by the Management Company to be duly filled by the investor to change his/her particulars and will be stated in this Offering Document.

  • Policy form means the form on which the policy is delivered or issued for delivery by the issuer.

  • Variation Form means the form that will be completed and signed by the Parties to effect a Variation which shall be in the form set out in Framework Schedule 19 (Variation Form);

  • Beneficiary Designation Form means the form established from time to time by the Plan Administrator that the Executive completes, signs, and returns to the Plan Administrator to designate one or more Beneficiaries.

  • Transfer Form means a standardized form prescribed by the Management Company to be duly filed by the investor to transfer Units and will be stated in this Offering Document.

  • Acceptance Form means the form provided by the School for parents to complete when accepting a place for their child at the School;

  • Certificate form means the form on which the certificate is delivered or issued for delivery by the issuer.

  • Case Report Form means a printed, optical or electronic document or database designed to record all of the information, which is required by the Protocol to be reported to the Sponsor on each Study Participant.

  • Account Application Form means the Personal Account Application Form for International Personal Banking or Wealth and Investment as applicable;

  • Consent Form means the forms provided to each holder of Pre-Formation Interests to consent to the Formation Transactions and to make such holder’s irrevocable elections with respect to consideration to be received in the Formation Transactions.

  • Book entry form or “book entry system” means a form or system under which (i) the ownership of book entry interests in Bonds and the principal of and interest on the Bonds may be transferred only through a book entry and (ii) physical Bond certificates in fully registered form are issued by the City only to a Depository or its nominee as registered owner, with the Bonds deposited and maintained in the custody of the Depository or its agent. The book entry maintained by others than the City is the record that identifies the owners of book entry interests in those Bonds and that principal and interest.

  • Distribution Election Form means the form established from time to time by the Plan Administrator that the Director completes, signs and returns to the Plan Administrator to designate the time and form of distribution.

  • Form of Election has the meaning assigned in Section 3.3(b).

  • Proxy Form means the proxy form attached to the Notice;