Get the free State Continuation Election / Premium Subsidy Attestation

This form allows employees to elect continuation coverage for group medical insurance under Oregon state law following loss of coverage due to specific reasons. It includes attestation for eligibility

How to fill out state continuation election premium

How to fill out State Continuation Election / Premium Subsidy Attestation

1. Obtain the State Continuation Election / Premium Subsidy Attestation form from your insurance provider or state health department.
2. Carefully read the instructions provided with the form to understand the eligibility and requirements.
3. Fill in your personal information, including your full name, address, and the date of the form submission.
4. Indicate the qualifying event that allows you to apply for continuation coverage, such as job loss or reduction in work hours.
5. Complete any section that asks for information about your current insurance plan and coverage options.
6. If applicable, provide details regarding family members who may also need to continue their coverage.
7. Review the form to ensure all information is accurate and complete.
8. Sign and date the attestation where required to certify the information provided.
9. Send the completed form to the designated address as indicated in the instructions.

Who needs State Continuation Election / Premium Subsidy Attestation?

1. Individuals who have lost their employer-sponsored health insurance due to qualifying events such as job loss, reduction in work hours, or other specified circumstances.
2. Family members of the covered individual who may also wish to continue their health coverage.

For pdfFiller’s FAQs

What is State Continuation Election / Premium Subsidy Attestation?

State Continuation Election / Premium Subsidy Attestation is a process that allows individuals to maintain their health insurance coverage after a qualifying event, such as a job loss or reduction in work hours, often with the assistance of premium subsidies.

Who is required to file State Continuation Election / Premium Subsidy Attestation?

Individuals who experience a qualifying event that affects their health insurance coverage are typically required to file this attestation to ensure they remain eligible for continued coverage and any associated premium subsidies.

How to fill out State Continuation Election / Premium Subsidy Attestation?

To fill out the attestation, individuals should provide personal information, details of their qualifying event, and any required documentation, ensuring accuracy to avoid delays in processing their continued coverage.

What is the purpose of State Continuation Election / Premium Subsidy Attestation?

The purpose of the attestation is to verify eligibility for continued health coverage and to apply for premium subsidies that help reduce the cost of maintaining insurance after a qualifying event.

What information must be reported on State Continuation Election / Premium Subsidy Attestation?

The information required typically includes the individual's name, contact details, insurance policy number, details of the event causing the coverage change, and any supporting documentation needed to validate the request.