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COBRA QUALIFYING EVENT OR EXTENSION NOTIFICATION This form is to be completed by a covered employee, spouse, or dependent to report certain events to Samaritan Health Plans, as required under provisions

How to fill out cobra qualifying event or

How to fill out cobra qualifying event or

1. To fill out a COBRA qualifying event:
2. Obtain the necessary forms from your employer or health plan administrator.
3. Verify your eligibility for COBRA continuation coverage.
4. Fill out the required personal information, such as your name, address, and contact details.
5. Provide details about the qualifying event, such as the date of the event and the reason for the event.
6. Indicate whether you are electing COBRA coverage for yourself, your spouse, and/or your dependents.
7. Submit the completed form to your employer or health plan administrator within the specified timeframe.
8. Pay the applicable premiums for COBRA coverage to maintain your health insurance benefits.

Who needs cobra qualifying event or?

1. COBRA qualifying event is for individuals who experience a loss of job or a reduction in work hours, and consequently lose their employer-sponsored health insurance.
2. It is also for individuals who experience certain life events, such as divorce or legal separation, the death of the covered employee, or the loss of dependent child status.
3. In such situations, these individuals may need the COBRA qualifying event to continue their health insurance coverage.

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