Get the free COBRA Qualifying Event Form

This form is for employers or their representatives to submit information regarding qualifying events for COBRA coverage within 30 days of the event.

How to fill out cobra qualifying event form

How to fill out COBRA Qualifying Event Form

1. Obtain the COBRA Qualifying Event Form from your employer or the plan administrator.
2. Fill in your personal information, including your name, address, and contact details.
3. Indicate the type of qualifying event (e.g., termination of employment, divorce, etc.) that triggered your COBRA eligibility.
4. Provide the dates of the qualifying event and any relevant employment details.
5. Sign and date the form to validate the information provided.
6. Submit the completed form to your employer or plan administrator within the required timeframe.

Who needs COBRA Qualifying Event Form?

1. Employees who have experienced a qualifying event, such as termination of employment or divorce, and wish to continue health insurance coverage under COBRA.
2. Dependents of employees who are also affected by the qualifying event.

People Also Ask about

Is COBRA qualifying health coverage?

Find out if you are eligible for COBRA COBRA eligibility has three basic requirements that must be met for you to get a continuation of coverage: Your group health plan must be covered by COBRA. A qualifying event must occur. You must be a qualified beneficiary for that event.

Is coming off COBRA a qualifying event?

Is your COBRA coverage about to expire? After months of not worrying about health insurance, do you know what to do next? Here's the good news: Rolling off of COBRA coverage is a qualifying event that opens a special enrollment period for you to purchase your own health coverage.

What is not a COBRA qualifying event?

Coverage provided under the FMLA is not COBRA coverage, and taking FMLA leave is not a qualifying event under COBRA.

What is the 60 day COBRA loophole?

You have 60 days to enroll in COBRA once your employer-sponsored benefits end. Even if your enrollment is delayed, you will be covered by COBRA starting the day your prior coverage ended.

What are the 7 COBRA qualifying events?

The following are qualifying events: the death of the covered employee; a covered employee's termination of employment or reduction of the hours of employment; the covered employee becoming entitled to Medicare; divorce or legal separation from the covered employee; or a dependent child ceasing to be a dependent under

Is losing COBRA subsidy a qualifying event on Reddit?

It's a QLE, yes. You have 60 days to use the QLE from when the subsidy expires. Beyond that, simply not paying for COBRA / allowing it to terminate won't be considered a QLE.

Can you fill out COBRA online?

Employers offering COBRA coverage have different methods for enrollment. Some may use third-party administrators with online registration, while others may use traditional paper methods through their HR department.

What is a COBRA qualifying event notice?

“Qualifying events” are events that cause an individual to lose group health coverage. The type of qualifying event determines who the qualified beneficiaries are and the period of time that a plan must offer continuation coverage. COBRA establishes only the minimum requirements for continuation coverage.

For pdfFiller’s FAQs

What is COBRA Qualifying Event Form?

The COBRA Qualifying Event Form is a document that allows an employee or their dependents to request continuation of health insurance coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) after a qualifying event such as job loss, reduction in hours, or other life events affecting health coverage.

Who is required to file COBRA Qualifying Event Form?

Any employee or eligible dependent who experiences a qualifying event that affects their health insurance coverage is required to file the COBRA Qualifying Event Form to initiate the process of electing for continued coverage.

How to fill out COBRA Qualifying Event Form?

To fill out the COBRA Qualifying Event Form, individuals must provide accurate information about their employment, the qualifying event, and details regarding the dependents covered under their health plan. Instructions on the form will guide users through the necessary steps.

What is the purpose of COBRA Qualifying Event Form?

The purpose of the COBRA Qualifying Event Form is to inform the health plan administrator about a qualifying event that enables eligible individuals to receive continuation of health insurance coverage as mandated by COBRA regulations.

What information must be reported on COBRA Qualifying Event Form?

The information that must be reported on the COBRA Qualifying Event Form includes the employee's name, address, and employment details, the type of qualifying event, the date of the event, and details of the dependents who are affected by the change in coverage.