Get the free Continuance of group health plan coverage election form

CONTINUANCE OF GROUP HEALTH PLAN COVERAGE ELECTION FORM SECTION A: TO BE COMPLETED BY EMPLOYER Name of Employer Date of Notice Name of Employee Plan Number Continuance Payments: The Due Date for each

How to fill out continuance of group health

How to fill out continuance of group health:

1. Obtain the necessary form: Contact your insurance provider or human resources department to request the continuance of group health form. They will provide you with the appropriate document to fill out.
2. Provide personal information: Start by filling out your personal details, such as your name, address, phone number, and social security number. Make sure to double-check the accuracy of the information provided.
3. Indicate the group health plan: Specify the name of the group health plan you want to continue. This may require you to provide the plan number or any other identifying information associated with your employer's health insurance plan.
4. Choose the continuation period: Select the length of time you wish to continue the group health coverage. This can vary depending on your specific circumstances, but common options include 18, 29, or 36 months of coverage.
5. Provide reason for continuation: In some cases, you may be required to provide a reason for seeking continuation of group health coverage. This could include situations such as job loss, divorce, or a change in eligibility.
6. Include any dependent information: If you need to continue coverage for dependents, make sure to include their names, social security numbers, and any other relevant details requested on the form.
7. Sign and date the form: Once you have completed all the necessary sections, sign and date the form. This confirms that the information provided is accurate to the best of your knowledge.

Who needs continuance of group health?

1. Employees facing job loss: If you are being laid off or terminated from your job, you may need to seek continuance of group health coverage to ensure uninterrupted access to healthcare services.
2. Divorced individuals: When going through a divorce, the previously shared health insurance coverage may no longer be available. Seeking continuance of group health can help bridge the gap until alternative coverage is obtained.
3. Individuals losing dependent status: If you are no longer eligible to be covered as a dependent under a group health plan due to age or other circumstances, continuance of group health may be necessary to secure continued access to healthcare.
4. COBRA eligibility: The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows individuals to continue group health coverage for a specific period. If you are eligible for COBRA benefits, filling out the continuance of group health form is essential to activate this coverage.

Remember, the specific requirements for filling out continuance of group health forms may vary depending on your insurance provider or employer. It is recommended to carefully read and follow the instructions provided with the form to ensure proper completion.

For pdfFiller’s FAQs

What is continuance of group health?

Continuance of group health refers to the process of maintaining health insurance coverage for a group of employees after a qualifying event, such as termination of employment.

Who is required to file continuance of group health?

Employers are typically required to file continuance of group health forms on behalf of their employees.

How to fill out continuance of group health?

Continuance of group health forms can be filled out online or through paper forms provided by the insurance company or employer.

What is the purpose of continuance of group health?

The purpose of continuance of group health is to ensure that individuals have the option to maintain their health insurance coverage after certain qualifying events.

What information must be reported on continuance of group health?

The information typically required on a continuance of group health form includes the individual's personal information, the reason for the qualifying event, and details of the health insurance plan.

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