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INSTRUCTIONS: To elect continuation coverage, complete this Election Form and return it to us. Under federal law, you must have 60 days after the date of this notice to decide whether you want to

How to fill out to elect continuation coverage

How to fill out to elect continuation coverage:

1. Contact your employer or insurance provider to obtain the necessary forms to elect continuation coverage.
2. Fill out the required personal information section, including your name, address, and contact information.
3. Specify the coverage period you wish to elect continuation for, such as the date of termination of your previous coverage.
4. Indicate the reason for electing continuation coverage, such as job loss, reduction in work hours, or eligibility for another qualifying event.
5. Provide any supporting documentation required to substantiate your eligibility for continuation coverage, such as termination letter or proof of reduction in work hours.
6. Review the completed form for accuracy and ensure all sections are filled out correctly.
7. Sign and date the form as required.
8. Submit the completed form to your employer or insurance provider by the specified deadline.

Who needs to elect continuation coverage:

1. Individuals who have experienced a qualifying event that results in the loss of their current health insurance coverage.
2. Employees who have been laid off, fired, or have voluntarily left their job.
3. Individuals who have experienced a reduction in work hours that makes them ineligible for their current employer-sponsored health insurance plan.
4. Dependents who were covered under a family member's health insurance plan and have become ineligible due to divorce, legal separation, or death of the primary policyholder.
5. Individuals who have aged out of their parents' health insurance plan or are no longer eligible as a dependent.

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What is to elect continuation coverage?

To elect continuation coverage means to choose to continue healthcare coverage beyond the original end date, usually due to a qualifying event such as the loss of a job or divorce.

Who is required to file to elect continuation coverage?

Individuals who experience a qualifying event that makes them eligible for continuation coverage are required to file to elect it.

How to fill out to elect continuation coverage?

To fill out to elect continuation coverage, individuals usually need to complete a specific form provided by their employer or insurance provider. This form typically requires personal identifying information, details about the qualifying event, and a chosen coverage option.

What is the purpose of to elect continuation coverage?

The purpose of electing continuation coverage is to ensure that individuals and their dependents have continued access to healthcare benefits after a qualifying event that would otherwise result in a loss of coverage.

What information must be reported on to elect continuation coverage?

When electing continuation coverage, individuals may need to report personal and contact information, details about the qualifying event, and the coverage option they wish to elect.