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HOUSE STAFF BENEFITS PLAN COBRA CONTINUATION COVERAGE ELECTION FORM Instructions: To elect COBRA continuation coverage, complete this Election Form and return into us. Under federal law, you have
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How to fill out cobra continuation coverage election

How to fill out cobra continuation coverage election
01
Contact your former employer's human resources department to request the necessary paperwork for COBRA continuation coverage election.
02
Carefully read the information provided in the COBRA election notice to understand your rights and options.
03
Fill out the election form completely and accurately, providing all requested information such as your personal details, coverage choices, and payment preferences.
04
Submit the completed form and any required payments by the specified deadline to ensure uninterrupted coverage.
Who needs cobra continuation coverage election?
01
Individuals who have lost their job or had their work hours reduced and were previously covered by their employer's group health insurance plan.
02
Dependents of covered employees who lose coverage due to the employee's qualifying event.
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What is cobra continuation coverage election?
Cobra continuation coverage election is a provision under the Consolidated Omnibus Budget Reconciliation Act (COBRA) that allows eligible employees and their dependents to continue their group health insurance coverage after experiencing a qualifying event, such as job loss or reduction in work hours.
Who is required to file cobra continuation coverage election?
Employees and their dependents who are entitled to continue health insurance coverage after a qualifying event are required to file a COBRA continuation coverage election.
How to fill out cobra continuation coverage election?
To fill out a COBRA continuation coverage election, individuals should complete the election form provided by their employer or plan administrator, indicating their choice to continue coverage, and submit it by the specified deadline.
What is the purpose of cobra continuation coverage election?
The purpose of COBRA continuation coverage election is to provide a way for individuals and families to maintain health insurance coverage during periods of unemployment or other qualifying events.
What information must be reported on cobra continuation coverage election?
The information that must be reported on a COBRA continuation coverage election includes the name of the qualified beneficiary, the group health plan, the specific qualifying event, and the election choice regarding continuation of coverage.
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