Get the free Cal-Cobra Election Form - HealthConnect Systems

Calibra Election Form P.O. Box 711 Fresno, CA 93712 www.SeeChangeHealth.com Main: 8888668733 Fax: 5592440458 Enroll SeeChangeHealth.com Employer Information Employer Name Employer Group ID Employee

How to fill out cal-cobra election form

How to fill out a Cal-COBRA election form:

1. Begin by obtaining the Cal-COBRA election form from your employer or the benefits administrator. Make sure to read the instructions carefully before starting to fill it out.
2. Provide your personal information in the designated sections of the form. This typically includes your full name, contact information, and employee identification number.
3. Indicate the reason for your COBRA eligibility. This could be due to job loss, reduction in work hours, or other qualifying events.
4. Select the coverage options you wish to elect. This may include medical, dental, vision, and/or prescription drug coverage. Choose the duration of coverage you desire, which is usually up to 18 months or longer in certain circumstances.
5. If you have dependents, list their information accurately. Dependents may include your spouse, children, or any other individuals covered under your previous employer's health insurance plan.
6. If applicable, specify the alternative coverage source you have chosen if you opt not to elect COBRA. This could be through a different employer's plan, a private individual plan, or a government-sponsored program like Medicaid.
7. Confirm your understanding of the cost associated with COBRA coverage. This may require indicating whether you will pay premiums monthly or quarterly, or if you are eligible for any subsidies or assistance programs.
8. Read the attestation section carefully and sign the form to certify the accuracy of the information provided. Provide the date of the signature as well.
9. Submit the completed Cal-COBRA election form as instructed, either by mailing it to the designated address or by submitting it electronically if applicable.
10. Retain a copy of the form for your records.

Who needs a Cal-COBRA election form?

1. Employees who have experienced a qualifying event that makes them eligible for continuation health insurance coverage.
2. Individuals who were previously covered under an employer-sponsored health insurance plan and want to maintain their coverage for a limited time after the qualifying event.
3. Dependents of employees who need to continue their health insurance coverage after the qualifying event.
4. Individuals who want to explore and compare COBRA coverage options and alternative coverage sources before making a decision.

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What is cal-cobra election form?

The Cal-COBRA election form is a form that allows employees to elect to continue their health insurance coverage under Cal-COBRA.

Who is required to file cal-cobra election form?

Employees who experience a qualifying event that triggers their eligibility for Cal-COBRA are required to file the Cal-COBRA election form.

How to fill out cal-cobra election form?

Employees can fill out the Cal-COBRA election form by providing their personal information, selecting the coverage options, and signing the form.

What is the purpose of cal-cobra election form?

The purpose of the Cal-COBRA election form is to allow employees to continue their health insurance coverage after experiencing a qualifying event.

What information must be reported on cal-cobra election form?

The Cal-COBRA election form must include the employee's personal information, the qualifying event that triggered their eligibility, and the coverage options selected.