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** MAIL THIS COMPLETED FORM WITH YOUR PREMIUM AND BILLING CHARGE PAYMENT TO: The Lincoln National Life Insurance Company, P Box 0821, Carol Stream, IL 60132-0821. O. CONTINUATION OF COVERAGE FORM

How to fill out continuation of coverage form

How to fill out continuation of coverage form:

1. Locate the continuation of coverage form: The first step is to find the continuation of coverage form. This form is usually provided by your insurance company or employer. You can check with your HR department or reach out to your insurance provider to obtain the form.
2. Read the instructions: Before filling out the form, carefully read the instructions provided. This will help you understand the requirements and any specific information you need to provide. Make sure you have all the necessary supporting documents and information handy.
3. Personal information: Start by filling out your personal information on the form. This may include your full name, address, phone number, social security number, and any other requested details. Double-check the accuracy of the information before moving on.
4. Previous coverage details: Next, you will need to provide details about your previous coverage. This may include the name of your previous insurance company, policy number, and the dates of coverage. If you had coverage through an employer, you might need to provide additional information such as the employer's name and contact information.
5. Reason for continuation: Indicate the reason why you require continuation of coverage. This could be due to a change in employment, loss of eligibility under a previous plan, or any other qualifying event that allows you to continue coverage.
6. Select continuation options: Depending on your circumstances, you may have different options for continuation of coverage. Choose the appropriate option that suits your needs and mark it on the form. Common options may include electing to continue the same coverage or selecting a new plan offered by the same insurance provider.
7. Signature and submission: Once you have completed the form, carefully review all the information provided. Ensure that it is accurate and complete. Sign the form where required and make a copy for your records. Submit the form to the appropriate party, such as your HR department or insurance provider, according to their instructions.

Who needs continuation of coverage form:

1. Individuals transitioning between jobs: When switching jobs, there might be a gap in insurance coverage. The continuation of coverage form allows these individuals to maintain the same or similar insurance benefits during this transition period.
2. Qualified beneficiaries under COBRA: The Consolidated Omnibus Budget Reconciliation Act (COBRA) provides the option for employees and their dependents to continue health insurance coverage in certain circumstances, such as job loss or reduction in work hours. These individuals need to fill out the continuation of coverage form to exercise their COBRA rights.
3. Individuals with other qualifying events: Apart from job loss, various other life events can make someone eligible for continuation of coverage. These events might include divorce, death of a spouse, or aging out of a parent's insurance plan. The continuation of coverage form helps individuals in such situations maintain their health insurance benefits.

Remember to consult with your insurance company or employer for specific instructions and requirements regarding the continuation of coverage form.

For pdfFiller’s FAQs

What is continuation of coverage form?

Continuation of coverage form is a document that allows individuals to extend their health insurance benefits beyond the original coverage period.

Who is required to file continuation of coverage form?

Individuals who wish to continue their health insurance coverage after the original coverage period ends are required to file a continuation of coverage form.

How to fill out continuation of coverage form?

To fill out a continuation of coverage form, individuals must provide personal information, details of the original insurance coverage, and indicate their desire to continue coverage.

What is the purpose of continuation of coverage form?

The purpose of the continuation of coverage form is to allow individuals to maintain their health insurance benefits beyond the original coverage period.

What information must be reported on continuation of coverage form?

Information such as personal details, original insurance policy information, and the desired continuation period must be reported on the continuation of coverage form.

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