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COBRA CONTINUATION OF COVERAGE APPLICATION An Independent Licensee of the Blue Cross and Blue Shield Association 450 River chase Parkway East P. O. Box 995 Birmingham, Alabama 352980001 (205) 9882200
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How to fill out COBRA - Blue Cross:

01
Gather relevant information: Before filling out the COBRA - Blue Cross form, you will need certain information such as your personal details, the reason for your previous insurance termination, and any dependents you wish to include.
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Obtain the COBRA - Blue Cross forms: You can typically obtain the necessary COBRA - Blue Cross forms from your previous employer's human resources department or directly from Blue Cross.
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Read the instructions: Take the time to carefully read through the instructions provided with the COBRA - Blue Cross forms. This will ensure that you understand what information needs to be provided and how to accurately complete the form.
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Complete the personal information section: Start by filling out the personal information section of the COBRA - Blue Cross form. This includes details such as your full name, address, contact information, and social security number.
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Provide details about your previous insurance termination: You will need to provide information about the reason for your previous insurance termination. This may include job loss, reduction in work hours, or other qualifying events.
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Include any dependents: If you wish to include any dependents in your COBRA - Blue Cross coverage, provide their full names, social security numbers, and relationship to you.
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Review and double-check: Once you have completed all the required sections of the COBRA - Blue Cross form, go through it again to ensure that all the information you provided is accurate and complete.
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Submit the form: After reviewing the form and confirming its accuracy, submit it to the appropriate party, which is typically your previous employer's human resources department or Blue Cross.

Who needs COBRA - Blue Cross:

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Individuals who have recently lost their job: COBRA - Blue Cross is often needed by individuals who have lost their job and want to continue their health insurance coverage.
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Former employees who had health insurance through their employer: If you had health insurance coverage through your previous employer and are no longer eligible for it, COBRA - Blue Cross can provide a continuation of that coverage.
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COBRA stands for Consolidated Omnibus Budget Reconciliation Act. It allows employees to continue health insurance coverage after leaving a job. Blue Cross is a type of health insurance provider.
Employers with 20 or more employees who offer a group health insurance plan are required to offer COBRA coverage.
Employees can fill out COBRA enrollment forms provided by their employer or insurance provider.
The purpose of COBRA is to ensure that employees and their dependents can continue to have health insurance coverage after a job loss or other qualifying event.
COBRA forms typically require information about the employee, coverage details, and payment options.
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