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Este documento permite a los empleados continuar su cobertura de seguro de accidente, enfermedad crítica/enfermedad específica y/o indemnización hospitalaria después de dejar su empleo, con instrucciones sobre cómo completar la solicitud y los requisitos para mantener la cobertura.
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How to fill out extended continuation election

01
Gather all necessary information regarding your current benefits and eligibility.
02
Obtain the extended continuation election form from your employer or plan administrator.
03
Carefully read the instructions provided with the form.
04
Fill out your personal details accurately, including your name, address, and contact information.
05
Specify the type of coverage you wish to continue.
06
Indicate the dates for which you are requesting the extended continuation of coverage.
07
Review the payment options and write down your payment preference.
08
Sign and date the form to certify the information provided.
09
Submit the completed form to the designated individual or department within the specified timeframe.

Who needs extended continuation election?

01
Individuals who have recently experienced a qualifying event that affects their health insurance coverage, such as termination of employment or a reduction in work hours, may need extended continuation election.
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An extended continuation election allows eligible individuals to continue their group health coverage under certain circumstances, typically after employment ends or if they experience a qualifying event.
Individuals who have experienced a qualifying event, such as job loss, that allows them to elect continued coverage under COBRA or similar state laws are required to file an extended continuation election.
To fill out an extended continuation election, individuals must complete the required form provided by their former employer or health plan, indicating their desire to elect continued coverage and providing necessary personal information.
The purpose of an extended continuation election is to provide individuals and families with the option to maintain their health coverage after they experience a qualifying event that would otherwise end their group health plan.
The information that must be reported typically includes the individual's name, address, the qualifying event date, and any required signatures, along with any payment details for continued coverage premiums.
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