Get the free Cal-COBRA Continuation: Family Members

This document is a notice and application for COBRA continuation coverage for family members not previously covered under a group health plan. It outlines eligibility, qualifying events, and instructions

How to fill out cal-cobra continuation family members

How to fill out Cal-COBRA Continuation: Family Members

1. Obtain the Cal-COBRA Continuation Coverage application form from your employer or health insurance provider.
2. Fill out the personal information section including your name, address, and contact information.
3. List the family members who are eligible for continuation coverage, including their names and relationships to you.
4. Provide the necessary details such as date of birth and social security numbers for each family member listed.
5. Indicate the type of coverage you wish to continue (e.g., individual, family plan).
6. Review the completed application for accuracy and completeness.
7. Submit the application by the indicated deadline to the appropriate address provided by your employer or insurer.
8. Maintain a copy of the submitted application for your records.

Who needs Cal-COBRA Continuation: Family Members?

1. Individuals who have experienced a loss of group health insurance due to certain qualifying events such as job loss or reduction in work hours.
2. Dependents of individuals who are eligible for Cal-COBRA continuation coverage.
3. Employees of small businesses (2-19 employees) who do not qualify for regular COBRA coverage.

People Also Ask about

Can I have COBRA and covered California at the same time?

If you have both COBRA coverage and Covered California at the same time, and you receive financial help to help you pay your Covered California premium, when you file your federal taxes, state taxes, or both, you will have to pay back some or all of the financial help you received for the months that you also had COBRA

What are the 7 Cobra qualifying events in California?

The seven COBRA qualifying events that allow individuals to maintain their employer-sponsored health insurance include termination of employment for reasons other than gross misconduct, reduction in the number of work hours, divorce or legal separation from the covered employee, the covered employee becoming entitled

Is cobra permanent?

COBRA provides coverage for at least 18 months (to a maximum of 36 months), giving you time to find more permanent coverage. COBRA makes it easier to keep your existing doctors and pharmacists who might be out of network when you switch to a new plan.

For pdfFiller’s FAQs

What is Cal-COBRA Continuation: Family Members?

Cal-COBRA Continuation: Family Members is a state program in California that allows certain family members of employees who lose their group health insurance coverage to continue their health benefits for a limited time.

Who is required to file Cal-COBRA Continuation: Family Members?

Employers with 2 to 19 employees are required to file Cal-COBRA Continuation for eligible family members when a qualifying event occurs, such as the employee's termination or reduction in hours.

How to fill out Cal-COBRA Continuation: Family Members?

To fill out the Cal-COBRA Continuation for Family Members, the employer must provide necessary forms to the eligible family members, who must then complete the forms, providing details like their identification, the qualifying event, and any other required information.

What is the purpose of Cal-COBRA Continuation: Family Members?

The purpose of Cal-COBRA Continuation: Family Members is to provide individuals who have lost their group health insurance the opportunity to maintain their coverage, ensuring continued access to health care.

What information must be reported on Cal-COBRA Continuation: Family Members?

The information that must be reported includes the name and address of the covered family member, the qualifying event, coverage options available, and any relevant dates such as the start of coverage and duration.