Get the free Cal-COBRA Election Form - Blue Shield of California

Cal-COBRA Election Form Please return completed form to: Blue Shield of California Cal-COBRA, PO Box 629009, El Dorado Hills, CA 95762-9009. Blue Shield of California will accept those individuals

How to fill out cal-cobra election form

How to fill out the cal-cobra election form:

1. Start by obtaining the cal-cobra election form from your employer or health insurance provider. This form is typically provided to individuals who are eligible for cal-cobra coverage.
2. Carefully read through the instruction section of the form. This will provide you with important information about the eligibility criteria, deadlines, and documentation requirements.
3. Fill in your personal details accurately. This includes your name, address, phone number, and social security number. Make sure to double-check the information for any errors.
4. Indicate your reason for the cal-cobra election. This could be due to job loss, reduction in work hours, divorce, or other qualifying events. Provide any necessary supporting documentation if required.
5. Choose the type of cal-cobra coverage you wish to elect. You may have options for individual coverage, family coverage, or choose to decline coverage altogether.
6. Determine the duration of your cal-cobra coverage. This is typically based on the length of time specified by the cal-cobra law or the number of months you've already been enrolled in the previous health insurance plan.
7. Calculate and include your premium payment. You will need to determine the total amount due for the desired coverage period and submit the payment along with the form. Consult the instructions for acceptable payment methods.
8. Sign and date the form to certify the accuracy of the information provided. Ensure that all required fields are completed before submitting the form.

Who needs the cal-cobra election form:

1. Individuals who were covered under an employer-sponsored group health plan and experienced a qualifying event that resulted in the loss of their coverage.
2. Spouses, dependents, and domestic partners of individuals who were covered under an employer-sponsored group health plan and experienced a qualifying event.
3. Individuals who were previously covered under a health insurance plan but are no longer eligible due to specific events such as divorce, legal separation, or loss of dependent status.

Please note that the cal-cobra election form and its eligibility criteria may vary depending on your state. It is always recommended to consult with your employer or health insurance provider for specific instructions and requirements.

For pdfFiller’s FAQs

What is cal-cobra election form?

The cal-cobra election form is a form that allows eligible individuals to elect to continue their health insurance coverage under COBRA.

Who is required to file cal-cobra election form?

Individuals who experience a qualifying event that makes them eligible for COBRA coverage are required to file the cal-cobra election form.

How to fill out cal-cobra election form?

To fill out the cal-cobra election form, individuals must provide their personal information, the date of the qualifying event, and make their election to continue COBRA coverage.

What is the purpose of cal-cobra election form?

The purpose of the cal-cobra election form is to allow individuals to elect to continue their health insurance coverage under COBRA after experiencing a qualifying event.

What information must be reported on cal-cobra election form?

The cal-cobra election form must include personal information, the date of the qualifying event, and the individual's election to continue COBRA coverage.

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