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HOUSE STAFF BENEFITS PLANLACUSC, LACHarborUCLA, MLK Hospital & Rancho Los Amigos Center COBRA CONTINUATION COVERAGE ELECTION FORM Instructions: To elect COBRA continuation coverage, complete this

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How to fill out cobra continuation of health

01

Obtain the COBRA Election Notice from your employer.

02

Fill out the Election Form included in the COBRA Election Notice.

03

Provide the required personal information, including your name, address, and Social Security number.

04

Select the health plan coverage you wish to continue under COBRA.

05

Make the initial premium payment as specified in the COBRA Election Notice.

Who needs cobra continuation of health?

01

Individuals who were covered under their employer's group health plan and experience a qualifying event that results in loss of coverage may need COBRA continuation of health.

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What is cobra continuation of health?

COBRA continuation of health allows employees to continue their health insurance coverage after leaving their job or experiencing a qualifying event.

Who is required to file cobra continuation of health?

Employers with 20 or more employees must offer COBRA continuation coverage and are required to provide information on how to enroll.

How to fill out cobra continuation of health?

Employees must fill out the necessary paperwork provided by their employer to enroll in COBRA continuation of health.

What is the purpose of cobra continuation of health?

The purpose of COBRA continuation of health is to help individuals maintain health insurance coverage during certain life events, such as job loss or a reduction in work hours.

What information must be reported on cobra continuation of health?

COBRA continuation of health forms typically require information on the individual seeking coverage, the qualifying event, and payment details.

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