
Get the free Keep Your Health Coverage (COBRA)
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Covered California for Small Business
Change Request Form for Employers 2019
Check here if changes are
to be effective at renewal.
Must be received prior to renewal date. Fax completed form to (949)
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How to fill out keep your health coverage

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01
To fill out and keep your health coverage, follow these steps:
02
Gather all necessary information and documents. This may include your social security number, income information, current health insurance policy details, and any supporting documents.
03
Visit the official website of your health insurance provider or the healthcare marketplace.
04
Log in to your account or create a new account, if required.
05
Navigate to the section for updating or renewing your health coverage.
06
Provide accurate and up-to-date information about your household, income, and any changes in your circumstances.
07
Review all the information you have entered to ensure accuracy.
08
Submit the updated information and any required documents as instructed.
09
Pay any applicable premiums or fees, if necessary.
10
Make sure to keep a copy of the confirmation or receipt for future reference.
11
Follow up with your health insurance provider or marketplace if any further action is required or if you have any questions or concerns.
Who needs keep your health coverage?
01
Anyone who currently has health coverage and wants to maintain it needs to keep their health coverage.
02
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03
It is important for individuals to maintain their health coverage to ensure continued access to medical services and minimize potential financial risks.
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What is keep your health coverage?
Keep your health coverage refers to maintaining your health insurance policy to ensure continuous coverage for your medical needs.
Who is required to file keep your health coverage?
Individuals who have health insurance coverage are required to maintain and file their health coverage information.
How to fill out keep your health coverage?
To fill out keep your health coverage, you will need to provide information about your health insurance policy and coverage details.
What is the purpose of keep your health coverage?
The purpose of keep your health coverage is to ensure individuals have continuous access to healthcare services by maintaining their health insurance coverage.
What information must be reported on keep your health coverage?
Information such as insurance provider details, policy number, coverage period, and any changes in coverage must be reported on keep your health coverage.
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