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___, 2023[COBRA Qualified Beneficiary; \"Family of\" if more than one family member] [Address] [Address]Re: Deadline Extensions under COBRA Election FormsDear [COBRA Qualified Beneficiary; add \"Family
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What is COBRA Election Cover Letter (COVID Extensions) Form?

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The COBRA election form cover is a document provided to eligible employees and their dependents that outlines their rights under the Consolidated Omnibus Budget Reconciliation Act (COBRA) to continue their health insurance coverage after experiencing a qualifying event.
The employer maintaining a group health plan is required to provide the COBRA election form cover to employees and their qualified beneficiaries who may be eligible for COBRA continuation coverage.
To fill out the COBRA election form cover, individuals must provide personal information such as name, address, and identification numbers, then indicate their election to continue coverage, including the effective date and any applicable dependents.
The purpose of the COBRA election form cover is to inform individuals about their rights to continue health insurance coverage after a qualifying event and to provide them with the necessary steps to elect this option.
The information that must be reported on the COBRA election form cover includes the individual's contact information, details of the health plan coverage, qualifying event information, and instructions for electing coverage.
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