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STATE CONTINUATION OF COVERAGE ELECTION FORMS TEP 1 Employer Information (To Be Completed by Employer) Name of EmployerNumber of EmployeesEmployees Coverage Peristyle of Coverage Single ___/___/___to

How to fill out cobra continuation of coverage

How to fill out cobra continuation of coverage

1. Fill out the COBRA election form provided by your employer or the health insurance company.
2. Provide all necessary information, including your name, address, Social Security number, and the names of any dependents who are also electing coverage.
3. Choose the type of coverage you want to continue and indicate the start date.
4. Calculate the total premium cost based on the information provided in the election form.
5. Submit the completed form along with any required premium payment to the designated recipient, such as the health insurance company or your employer.
6. Keep a copy of the COBRA election form and proof of submission for your records.
7. Continue making timely premium payments to maintain your COBRA continuation coverage.

Who needs cobra continuation of coverage?

1. Anyone who experiences a qualifying event that causes them to lose their employer-sponsored health insurance needs COBRA continuation of coverage.
2. This includes individuals who are terminated from their job, have hours reduced, get divorced or legally separated from the covered employee, or lose dependent status.
3. COBRA is also relevant for retirees and their dependents who were previously covered by a group health plan.

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What is cobra continuation of coverage?

COBRA continuation of coverage allows employees to continue their health insurance coverage after leaving their job or experiencing a qualifying event.

Who is required to file cobra continuation of coverage?

Employers with 20 or more employees are generally required to offer COBRA continuation of coverage.

How to fill out cobra continuation of coverage?

Employees can fill out the necessary paperwork provided by their employer or benefits administrator to enroll in COBRA continuation of coverage.

What is the purpose of cobra continuation of coverage?

The purpose of COBRA continuation of coverage is to provide temporary health insurance coverage to employees and their dependents in case of job loss or other qualifying events.

What information must be reported on cobra continuation of coverage?

COBRA continuation of coverage forms typically require information such as the employee's name, qualifying event, and coverage options.