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P.O. Box 2870 Boise, Idaho 83701 (208) 3444546 Fax (208) 3444649 Delta Dental Plan of Idaho COBRA CONTINUED COVERAGE ELECTION I DO elect to continue coverage under the Group Contract. I understand

How to fill out cobra continued coverage election

How to Fill out COBRA Continued Coverage Election:

1. Start by obtaining the necessary COBRA election forms from your employer or the group health plan administrator. These forms may also be available online.
2. Provide the required personal information, such as your name, address, and contact details.
3. Indicate the reason for your eligibility for COBRA, such as job loss, reduction in work hours, or other qualifying events.
4. Select the type of coverage you wish to elect. You may have the option to choose the same coverage you had while employed or a different plan offered by the employer.
5. Specify the coverage start date. This is usually the day immediately following your group health plan coverage end date.
6. Include any eligible dependents who also want to continue coverage under COBRA. Provide their names, dates of birth, and relationship to you.
7. Review the completed form for accuracy and ensure all required fields are filled correctly.
8. Sign and date the form, certifying that the information provided is true and accurate to the best of your knowledge.
9. Submit the completed form to the employer or plan administrator within the specified time frame. Be aware of any deadlines for submitting the election form; failure to meet these deadlines may result in loss of COBRA coverage eligibility.

Who Needs COBRA Continued Coverage Election:

1. Individuals who have recently lost their job and were covered by an employer-sponsored group health plan.
2. Employees who experienced a reduction in work hours that caused them to lose their eligibility for group health benefits.
3. Dependents of covered employees who no longer qualify for coverage due to divorce, legal separation, or other qualifying events.
4. Individuals who need continued health coverage but are unable to enroll in another group health plan or individual health insurance plan immediately.
5. Those who want to maintain the same health coverage they had while employed, including access to the same network of healthcare providers.

Note: It is important to contact your employer or the group health plan administrator directly for specific instructions and guidance on how to fill out the COBRA continued coverage election form in your particular situation.

For pdfFiller’s FAQs

What is cobra continued coverage election?

COBRA continued coverage election allows eligible individuals to continue their health insurance coverage after a qualifying event.

Who is required to file cobra continued coverage election?

Employees or dependents who experience a qualifying event that causes a loss of health coverage are required to file COBRA continued coverage election.

How to fill out cobra continued coverage election?

To fill out COBRA continued coverage election, eligible individuals need to complete the necessary forms provided by their employer or the group health plan administrator.

What is the purpose of cobra continued coverage election?

The purpose of COBRA continued coverage election is to provide temporary health insurance coverage to individuals who would otherwise lose their benefits due to a qualifying event.

What information must be reported on cobra continued coverage election?

COBRA continued coverage election forms typically require information such as personal details, qualifying event details, and payment information.

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