Get the free Continuation of Coverage Application

This form allows members to apply for continuation of health coverage under federal COBRA or California\'s Cal-COBRA after qualifying events such as termination, resignation, or other specific circumstances. The application must be submitted within 30 days of the qualifying event date to ensure continued coverage.

How to fill out continuation of coverage application

How to fill out continuation of coverage application

1. Obtain the continuation of coverage application form from your health insurance provider or employer.
2. Read through the instructions and eligibility requirements provided with the application.
3. Fill in your personal information, including your name, address, and policy number.
4. Indicate the qualifying event that makes you eligible for continuation of coverage, such as job loss or reduction in hours.
5. Provide information on your dependents, if applicable, and their relationship to you.
6. Select the coverage options you wish to continue and the desired duration of coverage.
7. Review your application for accuracy and completeness.
8. Sign and date the application form.
9. Submit the application to the insurance provider or designated office within the specified time frame.

Who needs continuation of coverage application?

1. Employees who have experienced a job loss or reduction in hours.
2. Individuals who have lost health coverage due to divorce or legal separation.
3. Dependents of covered employees who are no longer eligible for coverage.
4. Individuals transitioning between jobs or those who have had their employer-sponsored coverage terminated.

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What is continuation of coverage application?

Continuation of coverage application is a process that allows individuals to maintain their health insurance coverage under specific circumstances, typically following events such as job loss, reduction in work hours, or other qualifying events.

Who is required to file continuation of coverage application?

Individuals who have experienced a qualifying event that affects their group health insurance coverage are required to file a continuation of coverage application to maintain their benefits.

How to fill out continuation of coverage application?

To fill out a continuation of coverage application, individuals should obtain the application form from their employer or insurance provider, complete required personal information, provide details about the qualifying event, and submit it by the specified deadline.

What is the purpose of continuation of coverage application?

The purpose of the continuation of coverage application is to provide individuals with an option to retain their health insurance benefits despite changes in their employment or personal circumstances.

What information must be reported on continuation of coverage application?

The application typically requires information such as the applicant's identification details, the qualifying event date, coverage plan information, and any dependents who will also require coverage.