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COBRA NOTICE CONTINUATION OF HEALTH BENEFITS COVERAGE UNDER COBRAHC08061011STATE HEALTH BENEFITS PROGRAMANDSCHOOL EMPLOYEES HEALTH BENEFITS Programs page is to be completed by Employer Please print
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How to fill out continuation of health benefits

01
To fill out the continuation of health benefits form, follow these steps:
02
Contact your employer or the Human Resources department to obtain the necessary form.
03
Read the instructions provided on the form carefully to understand the requirements and deadline for submission.
04
Provide your personal information, including your name, contact details, and employee identification number.
05
Indicate the reason for the continuation of health benefits, such as termination of employment, divorce, or loss of dependent status.
06
Choose the appropriate coverage option, such as individual or family, and specify the duration for which you need the benefits to continue.
07
Provide any additional documentation required to support your request, such as proof of termination or divorce papers.
08
Review the completed form for accuracy and make sure all necessary information is included.
09
Sign and date the form.
10
Submit the form to the designated party as instructed, such as your employer's HR department or the health insurance provider.
11
Keep a copy of the form for your records.

Who needs continuation of health benefits?

01
Continuation of health benefits is typically needed by individuals who experience certain qualifying events, such as:
02
- Termination of employment or reduction in work hours
03
- Divorce or legal separation
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- Loss of dependent status due to age or other reasons
05
- Death of the primary policyholder
06
In these situations, individuals may be eligible to continue their health benefits for a certain period of time under a program called COBRA (Consolidated Omnibus Budget Reconciliation Act) or similar state laws. It allows them to retain the same health insurance coverage, but they may be required to pay the full premium themselves.
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Continuation of health benefits is a program that allows individuals to keep their health insurance coverage after experiencing certain qualifying events that would otherwise result in the loss of coverage.
The individual who is experiencing a qualifying event such as job loss or reduction in work hours is required to file for continuation of health benefits.
To fill out continuation of health benefits, individuals must contact their employer or insurance provider for the necessary forms and instructions on how to complete the process.
The purpose of continuation of health benefits is to ensure that individuals and their families maintain access to health insurance coverage during times of transition or hardship.
The continuation of health benefits form typically requires information such as personal details, the qualifying event that triggered the need for coverage continuation, and any relevant documentation supporting the claim.
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