Get the free wisconsin state continuation election form

GROUP COVERAGE CONTINUATION ELECTION FORM (For Oregon groups with 19 or fewer employees) Date form distributed Effective date election period expires This form is to be completed whether you wish

How to fill out wisconsin state continuation election

How to fill out wisconsin state continuation election:

1. Obtain the forms: Contact the Wisconsin Department of Employee Trust Funds (ETF) or visit their website to download the necessary forms for the state continuation election.
2. Fill out personal information: Provide your name, address, Social Security number, and other required personal information as specified on the form.
3. Indicate continuation coverage: Check the box indicating your election for continuation coverage under the Wisconsin state continuation law.
4. Specify the qualifying event: State the reason for your need for continuation coverage, such as termination of employment or reduction of hours.
5. Choose coverage dates: Specify the start and end dates for the continuation coverage period. Note that you may be eligible for up to 18 months of coverage.
6. Sign and date the form: Ensure you sign and date the form to complete your application for the Wisconsin state continuation election.

Who needs wisconsin state continuation election:

1. Individuals who have recently experienced a qualifying event that resulted in the loss of employer-sponsored health insurance coverage in Wisconsin.
2. Employees who have had their work hours reduced and are no longer eligible for their employer's health insurance.
3. Dependents who were covered under a group health plan but lost coverage due to the primary policyholder's qualifying event.

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What is wisconsin state continuation election?

Wisconsin state continuation election is a process by which an employee who has experienced a qualifying event that results in the loss of group health insurance coverage can continue their coverage through the state continuation program.

Who is required to file wisconsin state continuation election?

Employees who have experienced a qualifying event and have lost group health insurance coverage are required to file a wisconsin state continuation election.

How to fill out wisconsin state continuation election?

To fill out a wisconsin state continuation election, the employee must complete the necessary forms provided by their employer or the insurance carrier. The forms typically require personal and contact information, details of the qualifying event, and acknowledgement of the continuation rights and responsibilities.

What is the purpose of wisconsin state continuation election?

The purpose of wisconsin state continuation election is to ensure that employees who experience a qualifying event and lose group health insurance coverage have the option to continue their coverage, providing them with continued access to healthcare benefits.

What information must be reported on wisconsin state continuation election?

The wisconsin state continuation election typically requires the employee to report personal information such as their name, address, and social security number. Additionally, they need to provide details about the qualifying event that led to the loss of coverage.