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Continuation Coverage Election Notice For use where coverage is subject to State continuation requirements during the period that begins with September 1, 2008, and ends with December 31, 2009. April

How to fill out continuation coverage election notice

How to fill out continuation coverage election notice:

1. Start by reviewing the notice: Carefully read through the continuation coverage election notice provided by your employer or the group health plan. Ensure that you understand the purpose of the notice and the information it contains.
2. Provide personal information: Fill in your personal details, including your full name, address, phone number, and email address. Make sure to provide accurate and up-to-date information to ensure proper communication.
3. Identify the qualifying event: Determine the reason for your eligibility for continuation coverage. Common qualifying events include the loss of a job, reduction in work hours, divorce, or death of the covered employee.
4. List eligible individuals: If you have dependents or family members who were covered under your employer's health plan, list them as eligible individuals. Include their full names and any other requested information to ensure their coverage continuation.
5. Choose the coverage type: Select the type of continuation coverage you wish to elect. Depending on the specific circumstances, you may have options such as individual coverage, family coverage, or coverage for a specific dependent.
6. Understand the coverage period: Review the duration of the continuation coverage, which is typically outlined in the notice. Make sure you are aware of how long you and your eligible dependents can maintain coverage under the plan.
7. Submit the notice: Follow the instructions provided in the continuation coverage election notice to submit the completed form. This may involve returning the notice to your employer or directly to the group health plan administrator.

Who needs continuation coverage election notice:

1. Individuals experiencing a qualifying event: Anyone who goes through a qualifying event that results in the loss of group health plan coverage may need a continuation coverage election notice. Common qualifying events include job loss, divorce, or the death of the covered employee.
2. Dependent family members: In many cases, dependent family members who were covered under the group health plan may also need to fill out a continuation coverage election notice to maintain their health coverage after the qualifying event.
3. Employees with reduced work hours: If an employee's work hours are reduced, resulting in the loss of their eligibility for the group health plan, they may need to complete a continuation coverage election notice to secure the coverage for themselves or their dependents.

Remember, specific eligibility requirements may vary depending on the employer's health plan and applicable laws. It is important to carefully review the continuation coverage election notice and seek guidance from your employer or the group health plan administrator if you have any questions or need further clarification.

For pdfFiller’s FAQs

What is continuation coverage election notice?

Continuation coverage election notice is a notification that allows individuals to continue their health insurance coverage after certain qualifying events.

Who is required to file continuation coverage election notice?

Employers are required to provide employees with a continuation coverage election notice.

How to fill out continuation coverage election notice?

Continuation coverage election notice can be filled out by providing personal information, selecting coverage options, and submitting the form to the insurance provider.

What is the purpose of continuation coverage election notice?

The purpose of continuation coverage election notice is to give individuals the option to maintain health insurance coverage in certain situations where it would otherwise be terminated.

What information must be reported on continuation coverage election notice?

Continuation coverage election notice must include information about the individual's health insurance plan, qualifying event, and coverage options.

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