Get the free 2017 COBRA Election/Change form (Continuation of Coverage). 2017 COBRA Election/Chan...

Clear Form2017 COBRA Election/Change (Continuation of Coverage) Type or print clearly in black ink. Inaccurate, incomplete, or illegible information may delay coverage. We must receive this form no

How to fill out 2017 cobra electionchange form

How to fill out 2017 cobra electionchange form

1. Step 1: Download the 2017 COBRA Election/Change Form from the official website or obtain a physical copy from your employer.
2. Step 2: Fill out the top section of the form with your personal information, including your name, address, and social security number.
3. Step 3: Indicate the reason for your election/change, such as termination of employment or a qualifying event.
4. Step 4: Provide the details of your previous coverage, including the start and end dates and the name of the insurance plan.
5. Step 5: Select the coverage you wish to elect/change and indicate the effective date of the coverage.
6. Step 6: Sign and date the form, certifying the accuracy of the information provided.
7. Step 7: Submit the completed form to your employer or the designated entity responsible for COBRA administration.
8. Step 8: Keep a copy of the filled-out form for your records.

Who needs 2017 cobra electionchange form?

1. Anyone who is eligible for COBRA continuation coverage and wants to elect or make changes to their coverage for the year 2017 needs to fill out the 2017 COBRA Election/Change Form. This form is necessary for individuals who have experienced a qualifying event, such as termination of employment, and want to continue their health insurance coverage under the COBRA program.

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What is cobra electionchange form continuation?

COBRA Election Change Form Continuation is a form that allows individuals to make changes to their COBRA election after the initial election period has ended.

Who is required to file cobra electionchange form continuation?

Individuals who wish to make changes to their COBRA election after the initial election period has ended are required to file the COBRA Election Change Form Continuation.

How to fill out cobra electionchange form continuation?

To fill out the COBRA Election Change Form Continuation, individuals must provide their personal information and details of the changes they wish to make to their COBRA election.

What is the purpose of cobra electionchange form continuation?

The purpose of the COBRA Election Change Form Continuation is to allow individuals to adjust their COBRA election after the initial election period has ended.

What information must be reported on cobra electionchange form continuation?

The COBRA Election Change Form Continuation must include the individual's personal information and details of the changes they wish to make to their COBRA election.