Get the free State Continuation Notice Form (OAR 836-053-0863)

Health Net Health Plan of Oregon, Inc., Health Estate Continuation Election Form NOTICE TO MEMBER: To elect Oregon State Continuation Coverage, complete this election form and return it to your employer. You

How to fill out state continuation notice form

How to fill out state continuation notice form

1. Obtain a state continuation notice form from the appropriate state agency.
2. Fill out your personal information, including your name, address, and contact information.
3. Provide information about your current insurance coverage, including the name of the insurance company and the policy number.
4. Indicate the reason for requesting the continuation of coverage, such as job loss or change in family status.
5. Sign and date the form before submitting it to the state agency.

Who needs state continuation notice form?

1. Individuals who have experienced a qualifying event that allows them to continue their health insurance coverage under state law.

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What is state continuation notice form?

The state continuation notice form is a document that allows individuals to notify their state regulatory agency about the continuation of certain benefits or coverage after a qualifying event, such as a job loss or reduction in hours.

Who is required to file state continuation notice form?

Generally, employers or plan administrators are required to file the state continuation notice form on behalf of eligible employees or beneficiaries to ensure compliance with state continuation coverage laws.

How to fill out state continuation notice form?

To fill out the state continuation notice form, individuals or employers need to provide accurate information such as the employee's details, coverage start and end dates, reasons for continuation, and any relevant benefit information as specified in the form's instructions.

What is the purpose of state continuation notice form?

The purpose of the state continuation notice form is to inform eligible individuals of their rights to continue their health insurance coverage under state continuation laws, ensuring they have access to necessary medical benefits after employment changes.

What information must be reported on state continuation notice form?

The form typically requires information such as the employee's name, address, type of coverage, dates of coverage, qualifying event, and any pertinent details related to the continuation of benefits.