Get the free OHIO CONTINUATION ELECTION FORM

Fully insured by OHIO CONTINUATION ELECTION FORM SPOUSE AND CHILD(MEN) 400 Field Drive Lake Forest, IL 60045 To Be Completed By The Employer Insured s Name Date Social Security No. Group Number Home

How to fill out ohio continuation election form

How to fill out Ohio continuation election form:

1. Start by downloading the Ohio continuation election form from the official website of the Ohio Department of Insurance.
2. Fill out the top section of the form, providing your personal information such as your name, address, social security number, and contact details.
3. Move on to the section titled "Election" and indicate the type of continuation coverage you are electing. This could be either the federal Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage or the Ohio state continuation coverage.
4. If you are choosing federal COBRA coverage, provide the name of the plan administrator, the plan name, and the plan administrator's contact information.
5. Indicate whether you are electing coverage for yourself, your spouse, and/or your dependent(s), and specify the duration of the coverage.
6. If you are opting for Ohio state continuation coverage, provide details of the qualifying event that makes you eligible for this option.
7. Next, complete the "Certification" section by signing and dating the form, verifying that the information provided is accurate to the best of your knowledge.
8. Make a copy of the completed form for your records before submitting it to the appropriate entity, such as your employer or the insurance carrier.

Who needs the Ohio continuation election form?

1. Employees who have experienced a qualifying event and wish to continue their health insurance coverage.
2. Spouses and dependents of employees who have experienced a qualifying event and want to extend their health insurance.
3. Individuals who were covered under a group health plan and want to extend their coverage due to a loss of employment, reduction of work hours, death of an employee, or other qualifying events.

Please note that while the information provided here is a general guideline, it is important to refer to the official Ohio Department of Insurance website or consult with a qualified professional for specific instructions and requirements pertaining to the Ohio continuation election form.

For pdfFiller’s FAQs

How can I modify ohio continuation election form without leaving Google Drive?

You can quickly improve your document management and form preparation by integrating pdfFiller with Google Docs so that you can create, edit and sign documents directly from your Google Drive. The add-on enables you to transform your ohio continuation election form into a dynamic fillable form that you can manage and eSign from any internet-connected device.

Can I edit ohio continuation election form on an iOS device?

You certainly can. You can quickly edit, distribute, and sign ohio continuation election form on your iOS device with the pdfFiller mobile app. Purchase it from the Apple Store and install it in seconds. The program is free, but in order to purchase a subscription or activate a free trial, you must first establish an account.

How do I complete ohio continuation election form on an iOS device?

pdfFiller has an iOS app that lets you fill out documents on your phone. A subscription to the service means you can make an account or log in to one you already have. As soon as the registration process is done, upload your ohio continuation election form. You can now use pdfFiller's more advanced features, like adding fillable fields and eSigning documents, as well as accessing them from any device, no matter where you are in the world.