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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

How to fill out continuation of coverage application

Continuation of coverage application is required for individuals who are seeking to maintain their health insurance coverage after a certain event or circumstance. Here is a step-by-step guide on how to fill out the continuation of coverage application:

1. Start by obtaining the continuation of coverage application form from your health insurance provider. This can usually be done through their website or by contacting their customer service.
2. Carefully read through the instructions provided on the application form. Make sure you understand the eligibility requirements and any supporting documents that may be needed.
3. Provide your personal information such as your full name, address, contact details, and social security number. Ensure that the information is accurate and up to date.
4. Indicate the reason for your need for continuation of coverage. This might include circumstances such as loss of job, divorce, death of a spouse, or aging out of a parent's insurance plan.
5. Specify the type of coverage you wish to continue. This could be individual coverage, family coverage, or coverage for a specific dependent.
6. If you have lost your job, provide details of your previous employer including the name of the company, contact information, and dates of employment.
7. Include any additional information or documentation that may be required to support your eligibility for continuation of coverage. This may include proof of qualifying event, documentation of prior coverage, or proof of payment of premiums.
8. Review the completed application form for any errors or missing information. Ensure that all sections have been filled out accurately and completely.
9. Sign and date the application form. If applicable, have any required witnesses or notaries also sign and date the form.
10. Submit the completed application form to your health insurance provider as instructed. It is advisable to make a copy of the application for your records.

By following these steps, you can successfully fill out a continuation of coverage application and maintain your health insurance coverage during transitional periods or life events.

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What is continuation of coverage application?

Continuation of coverage application is a form that allows an individual to keep their existing health insurance coverage for a certain period of time.

Who is required to file continuation of coverage application?

Any individual who wants to keep their health insurance coverage after a qualifying event, such as losing a job or getting divorced, is required to file a continuation of coverage application.

How to fill out continuation of coverage application?

To fill out a continuation of coverage application, the individual needs to provide personal information, details of the qualifying event, and any other requested information by the insurance provider.

What is the purpose of continuation of coverage application?

The purpose of a continuation of coverage application is to ensure that individuals can maintain their health insurance coverage despite changes in their circumstances.

What information must be reported on continuation of coverage application?

Information such as personal details, details of the qualifying event, and any other requested information by the insurance provider must be reported on a continuation of coverage application.