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Request For Continuation CoverageConsolidated Omnibus Budget Reconciliation Act of 1985 (C.O.B.R.A.) Mail to: Blue Cross and Blue Shield of Oklahoma ATTN: Membership PO Box 655924, Dallas, TX 752655924PART

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How to fill out cobra request for continuation

01

Obtain the COBRA election form and notice from your employer.

02

Fill in your personal information, including name, address, and social security number.

03

Indicate the type of qualifying event that makes you eligible for COBRA continuation coverage.

04

Choose the health plan options you wish to continue under COBRA.

05

Sign and date the form, making sure to do so within the specified time frame.

Who needs cobra request for continuation?

01

Employees who are leaving their job for any reason

02

Spouses and dependents of employees who are losing coverage due to a qualifying event

03

Those who want to continue their employer-sponsored health insurance after leaving their job

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What is cobra request for continuation?

COBRA request for continuation is a form that allows individuals to continue their health insurance coverage after experiencing a qualifying event that would normally result in loss of coverage.

Who is required to file cobra request for continuation?

The individual who was covered under the employer-sponsored health insurance plan and experiences a qualifying event, as well as their dependents, are required to file the COBRA request for continuation.

How to fill out cobra request for continuation?

To fill out the COBRA request for continuation, individuals must provide their personal information, details of their qualifying event, and any other required information as specified by the employer's plan administrator.

What is the purpose of cobra request for continuation?

The purpose of the COBRA request for continuation is to allow individuals who have experienced a qualifying event to continue their health insurance coverage for a limited period of time.

What information must be reported on cobra request for continuation?

The COBRA request for continuation must include personal information of the individual and their dependents, details of the qualifying event, and any other relevant information as required by the plan administrator.

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