A
·
B
·
C
·
D
·
E
·
F
·
G
·
H
·
I
·
J
·
K
·
L
·
M
·
N
·
O
·
P
·
Q
·
R
·
S
·
T
·
U
·
V
·
W
·
X
·
Y
·
Z
·
OTHER
·

Directory Results for Each Permittee must complete this in its entirety, except for those requirements applicable only to the Principal Permittee - dpw lacounty to Each person ("qualified beneficiary") in the category(ies) checked below is entitled to elect COBRA continuation coverage, which will continue group health care coverage under the Plan for up to monthsenter 18 or 36, as appropriate and che

Each Permittee must complete this in its entirety, except for those requirements applicable only to the Principal Permittee - dpw lacounty
Each person ("qualified beneficiary") in the category(ies) checked below is entitled to elect COBRA continuation coverage, which will continue group health care coverage under the Plan for up to monthsenter 18 or 36, as appropriate and che