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COBRA Premium Payment Authorization Form Recurring Credit Card Payments FlexToday, Inc. COBRA Department 8009955373 COBRA@FlexToday.com COBRA premiums are due the first of the month for that month
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How to fill out cobra premium payment authorization

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How to fill out cobra premium payment authorization

01
Obtain the Cobra premium payment authorization form from your employer or insurance provider.
02
Fill out your personal information including name, address, and contact details.
03
Provide the details of your Cobra coverage including start date and coverage plan.
04
Authorize the payment by providing your banking information or credit card details.
05
Sign and date the form to confirm your authorization for premium payments.

Who needs cobra premium payment authorization?

01
Employees who have lost their job and are eligible for continued health insurance coverage under Cobra.
02
Individuals who are transitioning between jobs and need to maintain their health insurance coverage.
03
Retirees who are not yet eligible for Medicare and need to continue their employer-sponsored health insurance.
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COBRA premium payment authorization is a form that allows individuals to authorize the payment of their COBRA insurance premiums.
Any individual who is eligible for COBRA insurance coverage and wishes to continue their coverage by making premium payments.
Individuals can fill out the COBRA premium payment authorization form by providing their personal information, payment details, and authorization to deduct premiums from their account.
The purpose of COBRA premium payment authorization is to ensure that individuals who choose to continue their COBRA coverage are able to make timely premium payments.
Information such as the individual's name, address, contact information, payment details, and authorization signature must be reported on the COBRA premium payment authorization form.
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