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EMPLOYEE BENEFITS DIVISIONNYSHIP COBRA Coverage Option Change Form (for individuals currently on COBRA)(5/2021)Under federal law, you have 90 days from receipt of the date of this notice to decide

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How to fill out nyship cobra coverage option

01

Obtain the NYSHIP COBRA Coverage Option election form from your employer or benefits administrator.

02

Fill out your personal information including name, address, and contact information.

03

Indicate the reason for COBRA coverage (e.g. termination of employment, reduction in hours).

04

Select the coverage options you wish to elect (e.g. medical, dental, vision).

05

Sign and date the form, certifying that the information provided is accurate.

06

Submit the completed form by the deadline specified by your employer or benefits administrator.

Who needs nyship cobra coverage option?

01

Individuals who have lost their job and want to continue their health insurance coverage.

02

Dependents of covered employees who lose coverage due to divorce, death, or becoming ineligible for coverage.

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What is nyship cobra coverage option?

The NYSHIP COBRA coverage option allows individuals to continue their health insurance coverage after experiencing a qualifying event that would result in loss of coverage.

Who is required to file nyship cobra coverage option?

Employees and their dependents who lose health coverage due to a qualifying event are required to file for NYSHIP COBRA coverage option.

How to fill out nyship cobra coverage option?

To fill out the NYSHIP COBRA coverage option, individuals should contact their employer or the NYSHIP administrator for the necessary forms and instructions.

What is the purpose of nyship cobra coverage option?

The purpose of NYSHIP COBRA coverage option is to provide continued health insurance coverage for individuals and their dependents after a qualifying event.

What information must be reported on nyship cobra coverage option?

The NYSHIP COBRA coverage option requires individuals to report personal information, details of the qualifying event, and payment information for premiums.

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