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New COBRA Election Notice Form On May 8, 2013, the Department of Labor (DOL), in conjunction with its release of temporary guidance on Exchange Notices, issued a new COBRA model election notice, which

How to fill out new cobra election notice

1. The new COBRA election notice must be filled out by individuals who have recently experienced a qualifying event, such as the termination of employment, reduction in work hours, or a dependent's loss of eligibility for coverage under the employer's plan.
2. Start by carefully reviewing the new COBRA election notice form provided by your employer or plan administrator. This form should outline the necessary information and instructions for completing it.
3. Begin by entering your personal details, such as your name, address, and contact information, in the designated sections of the form.
4. Next, indicate the qualifying event that makes you eligible for COBRA coverage. This could be the loss of a job, reduction in hours, or another qualifying event specified in the form.
5. Provide information about the group health plan in which you were previously enrolled, including the name of the employer or plan administrator, the plan identification number, and any other relevant details requested on the form.
6. Declare whether you wish to elect COBRA continuation coverage for yourself, your spouse, and/or your dependent(s). If you choose not to elect COBRA coverage for yourself or any dependents, you must ensure that you understand the consequences of waiving this option.
7. If you decide to elect COBRA coverage, indicate the specific individuals you want to enroll in the continuation coverage, provide their names, and provide any additional information required, such as their social security numbers or dates of birth.
8. Finally, carefully read any statements or disclosures included in the form and sign and date the document where required. Make sure to keep a copy of the completed COBRA election notice for your records.

Remember, it's crucial to complete the new COBRA election notice accurately and promptly to ensure the continuation of your health insurance coverage. If you have any questions or need assistance, don't hesitate to reach out to your employer or plan administrator for guidance.

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