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CONTINUATION COVERAGE RIGHTS UNDER COBRA TO: Members of Both CompaniesDate:January 2016Introduction You are receiving this notice because you have recently become covered under a group health plan
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How to fill out continuation coverage rights

01
Understand if you are eligible for continuation coverage rights.
02
Obtain the necessary paperwork or forms to fill out for continuation coverage.
03
Read and follow the instructions on the forms carefully.
04
Provide accurate and complete information on the forms, including your personal details and the reason for requesting continuation coverage.
05
Attach any required supporting documentation, such as proof of qualifying event or loss of previous coverage.
06
Double-check the filled-out forms for any errors or missing information.
07
Submit the completed forms and any required documentation to the appropriate party within the specified time frame.
08
Keep copies of all submitted forms and documentation for your records.
09
Follow up with the party responsible for processing your continuation coverage request, if necessary.
10
Stay informed about your rights and responsibilities regarding continuation coverage, and ensure timely payment of premiums if applicable.

Who needs continuation coverage rights?

01
People who have experienced a qualifying event that makes them eligible for continuation coverage rights.
02
Those whose previous health insurance coverage has been terminated or lost due to specific circumstances, such as job loss, divorce, or aging out of a dependent status.
03
Individuals who wish to maintain their health insurance coverage after a qualifying event, ensuring they have access to necessary medical services and benefits.
04
Employees or dependents covered under certain group health plans, as defined by the law.
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Continuation coverage rights allow individuals to continue their health insurance after certain qualifying events.
Employers are required to notify employees of their continuation coverage rights and provide necessary paperwork.
Employees must complete the required forms provided by their employer and submit them by the deadline.
The purpose of continuation coverage rights is to ensure that individuals maintain health insurance coverage after a qualifying event such as job loss or divorce.
Information such as the effective date of coverage, reason for the qualifying event, and the cost of continuation coverage must be reported.
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