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Page 1 of 1 Waste Services Name ALLIED WASTE SERVICES OF NORTH AMERICA, LLC Phone Location Mailing Address City State Name 8017855935 225 W 700 S BLDG #2 675 GLADIOLA ST SALT LAKE CITY UT Zip Owner
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How to fill out COBRA IG:

01
Start by obtaining the COBRA IG form from your employer or health insurance provider.
02
Fill in your personal information accurately, including your name, address, and contact details.
03
Provide the necessary information about your previous health insurance coverage, such as the policy number and the start and end dates.
04
Indicate the reason for the loss of coverage, whether it's due to termination, reduction in hours, or other qualifying events.
05
Select the appropriate coverage options, such as medical, dental, or vision, depending on what you want to continue.
06
Calculate and enter the correct premium amount based on the instructions provided.
07
Sign and date the form to validate your submission.
08
Send the completed form to the designated address or submit it electronically, following the instructions provided.

Who needs COBRA IG:

01
Employees who have recently lost or will lose their job-based health insurance coverage.
02
Individuals whose work hours have been reduced significantly, causing them to lose their eligibility for employer-sponsored health benefits.
03
Spouses and dependents who were covered under an employee's health insurance but are no longer eligible due to divorce, legal separation, or the employee's death.
04
Retirees who were previously covered by their employer's health plan but are no longer eligible.
05
Those who experienced other qualifying events as defined by the Consolidated Omnibus Budget Reconciliation Act (COBRA).
Remember, it's important to consult your employer or health insurance provider for specific instructions and eligibility criteria related to filling out the COBRA IG form.
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Cobra ig, or Consolidated Omnibus Budget Reconciliation Act information gathering, is a process of collecting data related to COBRA coverage offered by employers to employees.
Employers who offer COBRA coverage to their employees are required to file cobra ig.
Cobra ig can be filled out electronically or manually by providing the necessary information about the COBRA coverage offered.
The purpose of cobra ig is to ensure compliance with COBRA regulations and provide accurate information about COBRA coverage.
Information such as employee details, coverage dates, premium amounts, and other COBRA-related data must be reported on cobra ig.
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