Get the free COBRA Continuation of Coverage Application Blue Shield of ...

COBRA Continuation of Coverage Application Blue Shield of California and Blue Shield of California Life & Health Insurance Company Employee information Last nameFirst nameSocial Security numberBlue

How to fill out cobra continuation of coverage

How to fill out cobra continuation of coverage

1. Determine eligibility: Ensure you were covered under a group health plan and experienced a qualifying event.
2. Notify the employer: Inform your employer or plan administrator about your qualifying event if they haven't already done so.
3. Request COBRA coverage: Obtain the COBRA election notice from your employer or plan administrator.
4. Review the notice: Read the notice carefully to understand your rights, coverage options, and deadlines.
5. Fill out the election form: Complete the COBRA election form provided in the notice, including all required information.
6. Submit the election form: Return the completed form to your employer or plan administrator by the deadline specified in the notice.
7. Pay premiums: Make timely payments for premiums as outlined in the notice to activate and maintain coverage.
8. Keep records: Maintain copies of correspondence and payments related to your COBRA coverage.

Who needs cobra continuation of coverage?

1. Individuals who have lost their job-based health insurance due to layoffs, reductions in hours, or other qualifying events.
2. Dependents of an insured individual who lose coverage due to the insured's death, divorce, or legal separation.
3. Employees who retire and are eligible for COBRA after leaving employment.
4. Those who want to continue their health insurance coverage for a limited time despite a qualifying event.

For pdfFiller’s FAQs

How do I modify my cobra continuation of coverage in Gmail?

You may use pdfFiller's Gmail add-on to change, fill out, and eSign your cobra continuation of coverage as well as other documents directly in your inbox by using the pdfFiller add-on for Gmail. pdfFiller for Gmail may be found on the Google Workspace Marketplace. Use the time you would have spent dealing with your papers and eSignatures for more vital tasks instead.

How can I send cobra continuation of coverage to be eSigned by others?

When you're ready to share your cobra continuation of coverage, you can swiftly email it to others and receive the eSigned document back. You may send your PDF through email, fax, text message, or USPS mail, or you can notarize it online. All of this may be done without ever leaving your account.

How do I make changes in cobra continuation of coverage?

With pdfFiller, the editing process is straightforward. Open your cobra continuation of coverage in the editor, which is highly intuitive and easy to use. There, you’ll be able to blackout, redact, type, and erase text, add images, draw arrows and lines, place sticky notes and text boxes, and much more.

What is cobra continuation of coverage?

COBRA continuation of coverage allows eligible employees and their dependents to continue their health insurance coverage for a limited time after qualifying events.

Who is required to file cobra continuation of coverage?

Employers with 20 or more employees who offer group health plans are required to provide COBRA continuation coverage to eligible employees and their dependents.

How to fill out cobra continuation of coverage?

To fill out COBRA continuation of coverage, you need to complete the COBRA enrollment form provided by your employer, ensuring all required personal and dependent information is included.

What is the purpose of cobra continuation of coverage?

The purpose of COBRA continuation coverage is to provide individuals who have lost their health insurance due to specific life events the opportunity to maintain their coverage temporarily.

What information must be reported on cobra continuation of coverage?

The information that must be reported includes the qualifying event, the individual's eligibility for coverage, coverage start and end dates, and the premium amount.