Get the free kaiser permanente cobra enrollment form

C.O.B.R.A. election form. Your Kaiser Permanent benefits will terminate on. Please complete this form if you wish to continue your current Kaiser Permanent ...

How to fill out kaiser permanente cobra enrollment

How to fill out kaiser permanente cobra enrollment:

1. Visit the official Kaiser Permanente website or contact their customer service to obtain the necessary forms for COBRA enrollment.
2. Fill out the personal information section of the enrollment form, including your name, address, and contact details.
3. Provide information about your previous coverage, such as the name of your employer and the date your previous coverage ended.
4. Select the type of coverage you are enrolling for, such as medical, dental, or prescription drug coverage.
5. Indicate the start date for your COBRA coverage and the duration of coverage you are eligible for.
6. Provide payment information for the COBRA premium. You may need to include a check or authorization for automatic deductions.
7. Review the completed enrollment form to ensure all information is accurate and legible.
8. Sign and date the form, and keep a copy for your records.
9. Submit the completed enrollment form to the designated Kaiser Permanente address or online portal as instructed.

Who needs kaiser permanente cobra enrollment:

1. Employees who have recently left or were terminated from a job that provided health insurance coverage through Kaiser Permanente.
2. Dependents of employees who were covered under the employer's Kaiser Permanente health insurance plan.
3. Individuals who were previously covered by Kaiser Permanente through a spouse's or parent's employer-sponsored health insurance plan but are no longer eligible for coverage due to a qualifying event such as divorce, death, or aging out of dependent status.

People Also Ask about kaiser permanente cobra enrollment form

How do I contact Kaiser Permanente Washington?

Call the New Member Welcome Team at 1-888-844-4607 (TTY 711) for support if: You have a scheduled surgery.

How to schedule an appointment with Kaiser Permanente in Washington?

Make an appointment online. Call us 24/7 at 1-800-813-2000 (TTY 711). Time: Same-day, next-day, evening, and weekend appointments available.

Who handles submitting a request for prior authorization?

Who is responsible for obtaining prior authorization? The healthcare provider is usually responsible for initiating prior authorization by submitting a request form to a patient's insurance provider.

How to submit prior authorization to Kaiser Permanente Washington?

Staff in Kaiser Permanente's Review Services department are available to accept your requests for authorization at 1-800-289-1363. We are available Monday through Friday from 8 a.m. to 5 p.m. PST.

What is the phone number for Kaiser WA provider?

If you still have a question, please call the Provider Assistance Unit toll-free at 1-888-767-4670. Monday through Friday, 8 a.m.-5 p.m.

For pdfFiller’s FAQs

What is kaiser permanente cobra enrollment?

Kaiser Permanente COBRA (Consolidated Omnibus Budget Reconciliation Act) enrollment refers to the option provided to individuals who have lost or are losing their job-based group health coverage. COBRA allows them to continue their health insurance coverage for a limited period, typically 18 to 36 months, by paying the full premium amount themselves. Kaiser Permanente is a health insurance provider that offers COBRA continuation coverage to eligible individuals, allowing them to maintain their healthcare benefits under their previous employer's plan.

How to fill out kaiser permanente cobra enrollment?

To fill out a Kaiser Permanente COBRA enrollment form, follow these steps: 1. Obtain the COBRA enrollment form: Visit the Kaiser Permanente website or contact their customer service to request a copy of the COBRA enrollment form. 2. Read the instructions: Take a few minutes to thoroughly read the instructions provided with the form. This will help ensure that you understand the process and complete the form accurately. 3. Provide personal information: Start by entering your personal details such as your full name, address, date of birth, social security number, and contact information. Make sure to provide all the information requested. 4. Indicate the coverage you want: Select the type of coverage you want to continue through COBRA. This could include medical, dental, or vision coverage. If you want to add or change any coverage options, specify that as well. 5. Specify dependents: If you have dependents that you want to include in your COBRA coverage, provide their details such as full name and date of birth. Indicate whether they are your spouse, child, or domestic partner. 6. Select applicable plans: Review the available health plans and indicate your choice for coverage. This may include selecting a specific plan, such as HMO or PPO, as well as optional services like dental or vision coverage. 7. Calculate premiums: Indicate whether you are enrolling for individual or family coverage and calculate the total premiums due. This information is typically available on the form or in the provided instructions. 8. Proof of qualifying event: Attach any necessary documents as proof of your qualifying event, such as termination letter, divorce decree, or death certificate. These documents may be required to verify your eligibility for COBRA. 9. Sign and date the form: Review the completed form, ensure all required sections are filled out accurately, and sign and date at the designated area. 10. Submit the form: Make a photocopy of the completed form for your records, and then send the original form to the address provided on the form or in the instructions. You may also be able to submit the form online, depending on Kaiser Permanente's procedures. Remember to keep a copy of your completed form, as well as any supporting documents, for your own records in case of future reference or inquiries.

What is the purpose of kaiser permanente cobra enrollment?

The purpose of Kaiser Permanente COBRA (Consolidated Omnibus Budget Reconciliation Act) enrollment is to provide continuation of health coverage to individuals who have lost or will lose their job-based health insurance due to certain qualifying events. COBRA allows eligible individuals and their dependents to continue receiving the same health insurance coverage, albeit at their own cost, for a specified period of time. This ensures uninterrupted access to healthcare services during the transition period until they can secure alternative coverage.

What information must be reported on kaiser permanente cobra enrollment?

When reporting Kaiser Permanente COBRA enrollment, the following information should be included: 1. Employee Information: Full name, address, phone number, Social Security number, date of birth, and employment status (terminated or laid off). 2. Qualified Beneficiary Information: Full name, address, phone number, Social Security number, date of birth, and relationship to the employee (spouse, dependent child). 3. Plan Coverage: Details about the specific health plan and coverage option chosen by the qualified beneficiary, such as medical, dental, and vision plans. 4. Effective Dates: The start and end dates of the COBRA coverage period for each qualified beneficiary. 5. Premium Payments: Information about the premium amount, frequency of payment (monthly, quarterly, etc.), and payment due date. 6. Notice and Election: A copy of the COBRA election notice, documenting that the qualified beneficiary has been provided with the required information and has elected COBRA coverage within the designated timeframe. 7. Payment Tracking: Records of premium payments received, including dates and amounts, to ensure accurate continuation of coverage. It is important to note that specific reporting requirements may vary based on the regulations and guidelines provided by Kaiser Permanente and any applicable federal or state laws.

What is the penalty for the late filing of kaiser permanente cobra enrollment?

The penalty for late filing of Kaiser Permanente COBRA enrollment would vary depending on the specific circumstances and the policies of Kaiser Permanente. It is recommended to contact Kaiser Permanente or review the COBRA enrollment guidelines provided by them to understand the specific penalty for late filing.

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