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P.O. Box 91060 Seattle, WA 98111-9160 P.O. Box 91060 Seattle, WA 98111-9160 CONTINUATION OF COVERAGE APPLICATION CONTINUATION OF COVERAGE APPLICATION Dear Enrolled: Dear Enrolled: Since your eligibility

How to fill out continued group coverage cobra

How to fill out continued group coverage COBRA:

1. Obtain the necessary forms: Begin by contacting your employer's human resources department or the COBRA administrator to request the paperwork required to enroll in continued group coverage COBRA. They should be able to provide you with the appropriate forms and instructions.
2. Review the information: Carefully read through all the documents provided, including the COBRA election notice, which outlines your rights and responsibilities. Make sure to understand the terms, coverage options, and any deadlines associated with the COBRA continuation.
3. Complete the enrollment form: Fill out the enrollment form accurately and completely. Provide all the requested personal information, such as your name, address, social security number, and contact details. You may also need to provide information about your previous health coverage and reasons for your eligibility for COBRA.
4. Choose your coverage: Select the specific coverage options you wish to continue under COBRA. This may include medical, dental, vision, and other benefits previously provided by your employer. If there are multiple coverage options available, carefully review the associated costs and coverage details before making your selection.
5. Calculate the premium payment: Determine the total premium amount for the COBRA coverage you have chosen. This amount is typically based on the full cost of the coverage plus an administration fee. It is crucial to accurately calculate this to ensure timely and correct payment.
6. Submit the forms: Once you have completed all the necessary forms and made copies for your records, submit them to the designated COBRA administrator or the HR department as instructed. Be sure to adhere to any specified deadlines mentioned in the COBRA notices to avoid losing your eligibility for continued coverage.

Who needs continued group coverage COBRA:

1. Those who have recently lost their job: Continued group coverage COBRA is typically available to employees who experienced a qualified event such as termination of employment. If you have recently lost your job and had health coverage through your employer, you may be eligible for COBRA, ensuring that you maintain health insurance during the transition period.
2. Dependents of covered employees: Dependent family members who were covered under a group health plan but lost their coverage due to a qualified event, such as divorce or the death of the employee, may also be eligible for continued group coverage COBRA. This allows them to maintain access to the same health benefits they had before.
3. Individuals transitioning between jobs: COBRA acts as a bridge for individuals transitioning between jobs and experiencing a gap in health coverage. If your new employer's health insurance coverage does not become effective immediately, enrolling in continued group coverage COBRA can provide temporary coverage until your new benefits begin.

Remember, the specifics of COBRA eligibility and coverage may vary depending on various factors, such as the size of the employer and state laws. It is advisable to consult the provided COBRA notices, your employer, or a legal professional for personalized guidance regarding your situation.

For pdfFiller’s FAQs

What is continued group coverage cobra?

COBRA stands for Consolidated Omnibus Budget Reconciliation Act. Continued group coverage COBRA allows employees to continue their health insurance coverage after leaving their job.

Who is required to file continued group coverage cobra?

Employers with 20 or more employees are required to offer continued group coverage COBRA to eligible employees.

How to fill out continued group coverage cobra?

Employees must fill out the necessary paperwork provided by their employer to enroll in continued group coverage COBRA.

What is the purpose of continued group coverage cobra?

The purpose of continued group coverage COBRA is to provide temporary health insurance coverage to employees and their dependents who would otherwise lose coverage due to a qualifying event.

What information must be reported on continued group coverage cobra?

Information such as the employee's name, qualifying event, start date of coverage, and premium payment details must be reported on continued group coverage COBRA forms.

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