Get the free COBRA Option Period form for PY 2024. COBRA Option Period form for PY 2024
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Employees Group Insurance Division
2024 OPTION PERIOD ENROLLMENT/CHANGE FORM
COBRA MEMBERS
If not making changes, do not return this form. All changes are effective Jan. 1, 2024
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How to fill out cobra option period form
How to fill out cobra option period form
01
Obtain the Cobra Option Period form from your employer or benefits administrator.
02
Fill out your personal information such as name, address, and contact details.
03
Indicate the reason for needing Cobra coverage (e.g. job loss, reduction in hours).
04
Select the coverage options you wish to continue under Cobra.
05
Sign and date the form before submitting it to the appropriate party.
Who needs cobra option period form?
01
Employees who have recently lost their job or experienced a reduction in hours and want to continue their employer-sponsored health insurance.
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What is cobra option period form?
Cobra option period form is a document that allows individuals to elect to continue their health insurance coverage under COBRA.
Who is required to file cobra option period form?
Individuals who experience a qualifying event that triggers COBRA eligibility are required to file the cobra option period form.
How to fill out cobra option period form?
The cobra option period form can typically be filled out online or by mail. It requires personal information, details about the qualifying event, and the selection of health coverage options.
What is the purpose of cobra option period form?
The purpose of the cobra option period form is to provide individuals with the opportunity to extend their health insurance coverage after experiencing a qualifying event.
What information must be reported on cobra option period form?
The cobra option period form typically requires information such as personal details, the qualifying event, health coverage selection, and payment details.
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