Get the free Cobra Election Form - Weber School District

COBRA ELECTION FORM For employees with insurance benefits: For insurance coverage to continue under COBRA you must complete and return this form to Weber School District HR/Payroll within 60 days

How to fill out cobra election form

How to fill out COBRA election form?

1. Obtain the COBRA election form from your employer or health insurance provider.
2. Carefully read through the instructions provided on the form to understand the requirements and deadlines for completing it.
3. Fill in your personal information accurately, including your full name, address, phone number, and social security number.
4. Provide details about your qualifying event, such as the date of termination or reduction in work hours that makes you eligible for COBRA coverage.
5. Indicate the coverage options you are electing, whether it is for yourself, your spouse, and/or your dependents.
6. Calculate the duration of coverage you want to elect, which can range from the date of your qualifying event to the maximum allowed period.
7. Review the information provided on the form to ensure its accuracy. Make corrections if necessary.
8. Sign and date the form to certify its completeness and accuracy.
9. Submit the completed form to your employer or health insurance provider within the specified timeframe.

Who needs COBRA election form?

1. Individuals who have experienced a qualifying event, such as termination or reduction in work hours, that makes them eligible for COBRA coverage.
2. Employees or their dependents who wish to continue their health insurance coverage after job loss or other qualifying events.
3. Individuals who want to retain the health insurance coverage offered by their previous employer for a specific period, typically up to 18 months but can be extended depending on certain circumstances.

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What is cobra election form?

The COBRA election form is a document that allows eligible individuals to choose whether or not they want to continue their health insurance coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) after experiencing a qualifying event, such as termination of employment.

Who is required to file cobra election form?

Any eligible individual who wishes to continue their health insurance coverage under COBRA is required to file the COBRA election form.

How to fill out cobra election form?

To fill out the COBRA election form, individuals must provide their personal information, details of the qualifying event, and indicate their election to continue COBRA coverage. The form can usually be obtained from the employer or the health insurance administrator.

What is the purpose of cobra election form?

The purpose of the COBRA election form is to give eligible individuals the opportunity to continue their health insurance coverage under COBRA, even if they would otherwise lose it due to a qualifying event.

What information must be reported on cobra election form?

The COBRA election form typically requires individuals to report their personal details (such as name, address, and contact information), details of the qualifying event, and their election to continue COBRA coverage.