Get the free COBRA Continuation Coverage Election Form (Outdated)

EMPLOYEE ELECTION FORM Please Print Clearly in CAPITAL letters New SubscriberMember adding line of coverageCompany Name:COBRA or State ContinuationWAIVER (signature required) KELLY Company ID:Right

How to fill out cobra continuation coverage election

How to fill out cobra continuation coverage election

1. Step 1: Receive notice of eligibility for COBRA continuation coverage from your employer
2. Step 2: Review the information provided in the notice regarding your options and deadlines for electing COBRA coverage
3. Step 3: Complete the election form provided by your employer, making sure to accurately fill in all required information
4. Step 4: Submit the completed election form to the designated individual or department at your employer within the specified deadline
5. Step 5: Make any required premium payments to maintain your COBRA coverage

Who needs cobra continuation coverage election?

1. Employees who have lost their job and their employer-sponsored health insurance
2. Dependents of employees who have lost their job and their employer-sponsored health insurance
3. Spouses of employees who have lost their job and their employer-sponsored health insurance

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What is cobra continuation coverage election?

COBRA continuation coverage election allows individuals to continue their group health insurance coverage after experiencing a qualifying event that would normally result in loss of coverage, such as job loss, reduction in hours, or other life changes.

Who is required to file cobra continuation coverage election?

The employer sponsoring the group health plan is required to provide the COBRA notice. Eligible employees or their dependents must file the COBRA continuation coverage election themselves.

How to fill out cobra continuation coverage election?

To fill out the COBRA continuation coverage election, the individual must complete the election form provided by the employer, indicating their choice to continue coverage, along with any necessary personal information and a signed acknowledgment.

What is the purpose of cobra continuation coverage election?

The purpose of COBRA continuation coverage election is to provide individuals who have lost their health coverage the opportunity to maintain their health insurance benefits temporarily, ensuring they have access to necessary medical care.

What information must be reported on cobra continuation coverage election?

The information that must be reported includes the name of the covered employee, the names of all qualified beneficiaries, the address, and the selection of coverage to be continued, along with any required payment details.