Get the free (VSP) COBRA Form - The California State University - calstate
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ELECT ION OF CONT NEED VI SI ON COVERAGE THROUGH COBRA Questions? Call 1.800.852.7600 ext. 4637 Group Names: Date of Qualifying Event: Date COBRA Coverage Begins: CALI FOR NI A STATE UNI VERSE TY
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What is vsp cobra form?
VSP COBRA form, also known as the Vision Service Plan Consolidated Omnibus Budget Reconciliation Act form, is a document used to maintain health insurance coverage for employees and their eligible dependents when they experience a qualifying event.
Who is required to file vsp cobra form?
Employers with 20 or more employees who provide a group health plan. Additionally, employees and their eligible dependents who experience a qualifying event such as job loss or reduction in work hours may also be required to file the VSP COBRA form.
How to fill out vsp cobra form?
To fill out the VSP COBRA form, you will need to provide information such as the qualifying event that triggered the need for COBRA coverage, the names and contact details of the individuals seeking coverage, the dates of the qualifying event, and the requested coverage start date.
What is the purpose of vsp cobra form?
The purpose of the VSP COBRA form is to allow individuals to continue their health insurance coverage when they experience a qualifying event that would otherwise cause a loss of coverage, such as job loss or reduction in work hours.
What information must be reported on vsp cobra form?
The VSP COBRA form typically requires information such as the names and contact details of the individuals seeking coverage, the qualifying event that triggered the need for COBRA coverage, the dates of the qualifying event, and the requested coverage start date.
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