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CBIA COBRA / State Continuation Services 350 Church Street Hartford CT 06103-1126 In addition if you have former employees and/or dependents currently enrolled in COBRA / State Continuation you ll need to complete and return a Continuant Takeover Form also included in this package. CBIASC SERVICE CORP COBRA/STATE CONTINUATION-OF-COVERAGE SERVICE AGREEMENT SIGNATURE PAGE Client Please return the page completed in the enclosed postage paid envelo...

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What is cbia cobra ct form?

The cbia cobra ct form is a form used to report information about corporate health insurance coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

Who is required to file cbia cobra ct form?

Employers with 20 or more employees who provide health insurance coverage under COBRA are required to file the cbia cobra ct form.

How to fill out cbia cobra ct form?

The cbia cobra ct form can be filled out electronically or manually. It requires information about the employer, the health insurance coverage, and the individuals covered under COBRA.

What is the purpose of cbia cobra ct form?

The purpose of the cbia cobra ct form is to provide the Internal Revenue Service (IRS) with information about COBRA coverage offered by employers and to ensure compliance with COBRA regulations.

What information must be reported on cbia cobra ct form?

The cbia cobra ct form requires reporting of employer information, coverage details, and individual information including names, social security numbers, and coverage start and end dates.

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