Get the free Cal-COBRA Enrollment Form

This form is used to request enrollment in a Kaiser Permanente Cal-COBRA account. It is necessary to provide information regarding your employer's group coverage and the enrollment reason.

How to fill out cal-cobra enrollment form

How to fill out Cal-COBRA Enrollment Form

1. Obtain the Cal-COBRA Enrollment Form online or from your insurance provider.
2. Fill out personal information, including your name, address, and contact details.
3. Provide your family member's information if you are enrolling dependents.
4. Indicate the qualifying event that allows you to enroll in Cal-COBRA.
5. Select the coverage option you desire, ensuring it matches your prior coverage.
6. Review the terms and conditions provided in the form.
7. Sign and date the form to certify the information is accurate.
8. Submit the completed form to your insurance provider within the required timeframe.

Who needs Cal-COBRA Enrollment Form?

1. Individuals who have recently experienced a qualifying event such as job loss, reduction in work hours, or loss of health coverage.
2. Employees and their dependents who previously had group health insurance through an employer.
3. Individuals who are not eligible for federal COBRA but may qualify for Cal-COBRA based on California state laws.

People Also Ask about

What is the difference between COBRA and cal-COBRA?

Federal COBRA generally extends health coverage for 18 months. Individuals with certain qualifying events may be eligible for a longer extension (e.g., 29 or 36 months). Cal-COBRA allows individuals to continue their group health coverage for up to 36 months.

Does Cal-COBRA still exist?

Much like federal COBRA, Cal-COBRA is a California law that lets you keep your group health plan when your job ends or your hours are cut. It may also be available to people who have exhausted their federal COBRA. Cal-COBRA applies to employers and group health plans that cover from two to 19 employees.

Can you fill out COBRA online?

Employers offering COBRA coverage have different methods for enrollment. Some may use third-party administrators with online registration, while others may use traditional paper methods through their HR department.

Who sends Cal-COBRA notices?

When employees or dependents experience a qualifying event, employers must provide an election notice within 14 days of the notice of the qualifying event, notifying them of their eligibility to enroll in Cal-COBRA coverage, the terms and amount of the premium payment, and the beginning and ending dates of coverage.

Who sends out COBRA paperwork?

A notice sent to the spouse is treated as a notification to all qualified dependent children residing with the spouse at the time the spouse's notification is sent by the plan administrator. Notices must be provided in person or by first class mail.

Who sends Cal-COBRA paperwork?

The HR office must provide the COBRA Election Notice and Election Form to qualified beneficiaries within 14 days from the date of the qualifying event or loss of coverage, or when the HR office is notified, whichever comes first.

For pdfFiller’s FAQs

What is Cal-COBRA Enrollment Form?

The Cal-COBRA Enrollment Form is a document that allows individuals to enroll in California's continuation health insurance coverage program, which extends health benefits after employment ends.

Who is required to file Cal-COBRA Enrollment Form?

Individuals who have lost their health insurance coverage due to certain qualifying events, such as job loss or reduction in hours, and who wish to continue their coverage under Cal-COBRA are required to file the form.

How to fill out Cal-COBRA Enrollment Form?

To fill out the Cal-COBRA Enrollment Form, individuals must provide personal information, including their name, address, and previous health plan details, as well as the qualifying event that led to the need for continuation coverage.

What is the purpose of Cal-COBRA Enrollment Form?

The purpose of the Cal-COBRA Enrollment Form is to facilitate the enrollment process for individuals seeking to continue their health insurance coverage after a qualifying event, ensuring they maintain access to necessary healthcare services.

What information must be reported on Cal-COBRA Enrollment Form?

The information that must be reported on the Cal-COBRA Enrollment Form includes personal identification details, the name of the previous health insurance plan, the date coverage ended, and the specific qualifying event that triggered the enrollment request.