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Request For Continuation Coverage Consolidated Omnibus Budget Reconciliation Act of 1985 (C.O.B.R.A.) Mail to: Blue Cross and Blue Shield of Oklahoma ATTN: Membership P.O. Box 3283 Tulsa, OK 74102-3283

How to fill out request for continuation coverage

How to fill out a request for continuation coverage:

1. Obtain the necessary forms: Start by obtaining the request for continuation coverage form from your employer or insurance provider. This form is typically known as the "COBRA Election Notice" or "HIPAA Special Enrollment Notice."
2. Read the instructions: Carefully read the instructions provided with the form. These instructions will guide you through the process and help you understand the information required to complete the form accurately.
3. Provide personal information: Begin by filling out your personal information such as your full name, address, contact information, and social security number. Make sure to double-check the accuracy of this information before moving forward.
4. Identify the qualifying event: Indicate the qualifying event that makes you eligible for continuation coverage. This could be the loss of a job, divorce, death of a covered employee, or other qualifying events as outlined in the form instructions.
5. Select the coverage option: Choose the coverage option that best suits your needs. You may have the option to continue the exact same coverage you had before the qualifying event or opt for a different plan if available.
6. Provide dependent information: If you have dependents who were covered under your previous insurance plan, provide their names and other necessary details as requested on the form.
7. Review and sign the form: Before submitting the form, review all the information you have provided to ensure its accuracy. Then, sign and date the form as required.

Who needs a request for continuation coverage?

1. Individuals experiencing a qualifying event: Anyone who has experienced a qualifying event that results in the loss of their existing health insurance coverage may require a request for continuation coverage. This could include employees who have lost their jobs, divorced spouses who were covered under their ex-partner's plan, or dependents who were covered under a deceased employee's insurance.
2. Those seeking to maintain healthcare coverage: The purpose of continuation coverage is to allow individuals to maintain the same or similar health insurance coverage after a qualifying event. If you wish to continue having health insurance without interruptions, you will need to submit a request for continuation coverage.
3. Individuals eligible for COBRA or HIPAA continuation coverage: In the United States, employees and their dependents who were covered under a group health plan may be eligible for COBRA (Consolidated Omnibus Budget Reconciliation Act) or HIPAA (Health Insurance Portability and Accountability Act) continuation coverage. These acts provide certain protections and allow individuals to continue their health insurance coverage for a specified period of time under certain circumstances.

Note: It is essential to consult the specific instructions provided by your employer or insurance provider to determine if you are eligible for continuation coverage and to understand the exact process and requirements for filling out the request form.

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What is request for continuation coverage?

Request for continuation coverage is a formal application to extend health insurance benefits after the original coverage has ended.

Who is required to file request for continuation coverage?

Individuals who have lost their health insurance coverage due to certain qualifying events, such as loss of employment, are required to file a request for continuation coverage.

How to fill out request for continuation coverage?

Request for continuation coverage can typically be filled out online through the health insurance provider's website or by contacting the human resources department of the employer.

What is the purpose of request for continuation coverage?

The purpose of request for continuation coverage is to ensure that individuals and their dependents have access to continued health insurance coverage after experiencing a qualifying event that would otherwise result in loss of coverage.

What information must be reported on request for continuation coverage?

The request for continuation coverage must include personal information such as name, address, and contact information, as well as details about the qualifying event that resulted in the loss of coverage.