Get the free 50-0136 PEBB Continuation Coverage Election/Change Form

Clear form2021 WEBB Continuation Coverage (COBRA) Election/Change We must receive this form no later than 60 days from the date your WEBB health plan coverage ends or from the postmark date on the

How to fill out 50-0136 pebb continuation coverage

How to fill out 50-0136 pebb continuation coverage

1. To fill out 50-0136 PEBB Continuation Coverage, follow these steps:
2. Begin by entering your personal information, such as your name, address, and contact details.
3. Provide details about your previous PEBB coverage, including the effective date and termination date of your previous coverage.
4. Indicate the reason for your coverage termination, such as termination of employment or divorce.
5. If applicable, enter the name and contact information of the new primary subscriber for continuation coverage.
6. Fill in the requested information regarding your dependent(s), including their names and relationship to you.
7. Specify the type of continuation coverage you are electing, whether medical, dental, or both.
8. Provide any additional necessary information, such as if you are eligible for Medicare or if there are special circumstances.
9. Read and sign the declaration at the bottom of the form, confirming the accuracy of the information provided.
10. Submit the completed form to the appropriate PEBB authority or mailing address.
11. Ensure that you double-check all the information provided before submitting the form.

Who needs 50-0136 pebb continuation coverage?

1. Individuals who were previously enrolled in PEBB coverage and experienced a qualifying event, such as termination of employment, divorce, or loss of dependent status, may need to fill out the 50-0136 PEBB Continuation Coverage form.
2. This form allows eligible individuals to continue their PEBB coverage for a specified period, ensuring continued access to medical and dental benefits.
3. It is important to consult the PEBB guidelines and eligibility requirements to determine if you qualify for continuation coverage.
4. Additionally, individuals who are eligible for Medicare or have other special circumstances may also need to consider filling out this form.
5. For specific eligibility and coverage details, refer to the PEBB Continuation Coverage guidelines or contact the appropriate PEBB authority.

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What is 50-0136 pebb continuation coverage?

50-0136 pebb continuation coverage refers to a program that allows individuals to continue their health insurance coverage after certain qualifying events such as termination of employment or reduction in hours.

Who is required to file 50-0136 pebb continuation coverage?

Employers who offer health insurance benefits through the PEBB (Public Employees Benefits Board) program and have eligible employees are required to file 50-0136 for continuation coverage.

How to fill out 50-0136 pebb continuation coverage?

To fill out 50-0136, you need to provide details such as the employee's information, qualifying event, and coverage options selected. It's important to follow the instructions provided on the form and ensure all required information is accurately completed.

What is the purpose of 50-0136 pebb continuation coverage?

The purpose of 50-0136 pebb continuation coverage is to ensure that individuals can maintain access to their health insurance benefits despite changes in their employment status, providing them with security and continuity of care.

What information must be reported on 50-0136 pebb continuation coverage?

The information that must be reported includes the employee's name, address, the date of the qualifying event, the type of coverage being continued, and any dependent information as applicable.