Get the free 84935 LA Health Continuation Form:Discovery new style

Contact us Tel: 0860 103 933, PO Box 652509, Kenmore, 2010, www.lahealth.co.za Continuation form Application to change a main member How to complete this application from This form is to be completed

How to fill out 84935 la health continuation

How to fill out 84935 LA health continuation:

1. Obtain the 84935 LA health continuation form from your employer or insurance provider.
2. Start by filling out your personal information, including your name, address, and contact information.
3. Provide your employment information, such as your job title and employer's name and address.
4. Indicate the type of coverage you are continuing, whether it's medical, dental, vision, or all of them.
5. If applicable, provide any dependent information, including names and relationship to you.
6. Enter the date on which your previous coverage ended, and the reason for the termination.
7. Indicate whether you currently have any other health coverage, such as through a spouse or parent.
8. Provide information about any other coverage you have, including the name of the insurance carrier and policy number.
9. Sign the form and date it to certify the accuracy of the information provided.
10. Submit the completed form to your employer or insurance provider as per their instructions.

Who needs 84935 LA health continuation?

1. Individuals who have recently lost their job and had health insurance through their previous employer.
2. Individuals whose employer offers continued health coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
3. Individuals who are eligible for continuation coverage due to other qualifying events, such as divorce or loss of dependent status.
4. Those who wish to continue their health coverage temporarily while they seek alternative insurance options.
5. Individuals who want to maintain the same insurance benefits they had through their previous employer, albeit at a higher cost.

Note: It is essential to consult with your employer or insurance provider for specific eligibility requirements and details about 84935 LA health continuation.

For pdfFiller’s FAQs

What is 84935 la health continuation?

84935 LA health continuation refers to the form used to provide information about continuing health coverage under Louisiana law.

Who is required to file 84935 la health continuation?

Employers in Louisiana who provide health coverage to employees are required to file Form 84935 LA health continuation.

How to fill out 84935 la health continuation?

Form 84935 LA health continuation can be filled out online or by mail, providing information about the health coverage offered to employees.

What is the purpose of 84935 la health continuation?

The purpose of Form 84935 LA health continuation is to report information about continuing health coverage offered to employees in compliance with Louisiana law.

What information must be reported on 84935 la health continuation?

Information such as the type of health coverage offered, number of employees covered, and details of the coverage must be reported on Form 84935 LA health continuation.

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