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THIS SECTION MUST BE COMPLETED Employee Member Number Health Group Number Dental Group Number Vision Group Number COBRA or State Continuation of Coverage Application Continuation of Medical/Dental
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How to fill out cobra or state continuation
How to fill out COBRA or state continuation:
01
Gather necessary information: Before filling out the COBRA or state continuation forms, you will need certain information such as the names and contact details of the eligible individuals who need coverage, the last day of employment, and the qualifying event that triggers the need for continuation coverage.
02
Obtain the forms: Contact your employer's benefits department or the insurance carrier to obtain the COBRA or state continuation forms. These forms may also be available on their website or through a third-party administrator.
03
Carefully read the instructions: Read the instructions provided with the forms thoroughly. These instructions will guide you on how to complete each section accurately.
04
Fill in personal information: Begin by filling in the required personal information for each eligible individual, including their full name, date of birth, and social security number. Make sure to double-check the accuracy of this information as any mistakes may delay the process.
05
Indicate the qualifying event: In the form, you will need to specify the qualifying event that makes the individual eligible for continuation coverage. This could be due to termination of employment, divorce, death of an employee, reduction of work hours, or any other qualifying event as defined by the law.
06
Choose the coverage options: Select the desired coverage options from the available choices provided on the form. This may include medical, dental, and vision coverage. Be sure to indicate whether you want to continue the same coverage or select different options if available.
07
Calculate the premiums: Determine the premium amounts for the selected coverage. The COBRA continuation coverage usually requires the individual to pay the full cost of the premiums, including the employer's portion. On the other hand, state continuation programs may have different rules and cost-sharing arrangements.
08
Provide payment information: Fill in the payment information section, such as the preferred method of payment, bank account details for automatic withdrawals, or how to send the payment via check. It's crucial to submit these payments on time to avoid any lapse in coverage.
09
Review and submit the forms: After completing the forms, review them carefully to ensure all information is accurate and complete. Sign and date the forms as required, and make copies for your records before submitting them to the appropriate entity indicated on the form.
Who needs COBRA or state continuation?
COBRA or state continuation coverage is typically needed by individuals who have recently experienced a qualifying event like the loss of a job, divorce, or reduction in work hours. It allows eligible individuals to continue their employer-provided health insurance coverage for a specific period, even when they are no longer part of the employer's group plan. COBRA applies to companies with 20 or more employees, while state continuation programs vary in eligibility and availability depending on the state. It is essential for those who require ongoing medical coverage during transitional periods until they secure alternative insurance options.
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What is cobra or state continuation?
COBRA, or the Consolidated Omnibus Budget Reconciliation Act, allows employees and their dependents the option to continue their health insurance coverage after experiencing a qualifying event.
Who is required to file cobra or state continuation?
Employers with 20 or more employees are required to offer COBRA continuation coverage to eligible employees and their dependents.
How to fill out cobra or state continuation?
Employers are responsible for providing employees with the necessary forms and information to enroll in COBRA continuation coverage.
What is the purpose of cobra or state continuation?
The purpose of COBRA continuation coverage is to ensure that individuals can maintain their health insurance after experiencing a qualifying event, such as job loss or reduction in hours.
What information must be reported on cobra or state continuation?
Employers must report information regarding the qualifying event, the individuals eligible for COBRA continuation coverage, and the terms of the coverage.
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