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  • Utah Insurance Department Continuation Coverage Election Notice Form 2019

Get Utah Insurance Department Continuation Coverage Election Notice Form 2019-2025

Utah mini-COBRA Continuation Coverage Election Notice Enter date of notice Dear: Identify the qualified beneficiary(ies), by name or status This notice contains important information about your right.

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How to fill out the Utah Insurance Department Continuation Coverage Election Notice Form online

This guide is designed to assist you in completing the Utah Insurance Department Continuation Coverage Election Notice Form online. It provides clear, step-by-step instructions to help you understand the form and ensure that you submit it correctly.

Follow the steps to complete the form efficiently.

  1. Click ‘Get Form’ button to download the form and open it in your preferred document editor.
  2. Begin by entering the date of the notice at the top of the form.
  3. Identify the qualified beneficiary or beneficiaries by name or status in the designated section of the form.
  4. Fill out the name of the group health plan as indicated on the form.
  5. Complete the checkboxes under the reasons for loss of coverage, making sure to select all that apply.
  6. Identify each person entitled to elect continuation coverage by filling out their name, date of birth, relationship to the employee, and social security number or other identifier.
  7. Sign and date the form to validate your election of continuation coverage.
  8. Provide your printed name, relationship to the individuals listed, and your current address and telephone number.
  9. Review all the information for accuracy and ensure that all required fields are completed.
  10. After completing, save your changes. You may download, print, or share the form through the options available in your document editor.

Complete the Utah Insurance Department Continuation Coverage Election Notice Form online to ensure your health care coverage continues without interruption.

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List Of States With Mini-COBRA Laws Arizona. Arkansas. California. Colorado. Connecticut. District of Columbia. Florida. Georgia.

1-877-262-7241.

If the Qualifying Event is termination of employment or a reduction of work hours, Qualified Beneficiaries may continue COBRA coverage for 18 months. If the Qualifying Event is death of the covered employee, divorce or legal separation, or loss of dependent status, COBRA coverage is available for 36 months.

Colorado Has A Mini-COBRA Law The difference is that it also requires small businesses with 19 or fewer employees to provide the same health benefits to workers that they had while employed.

On April 10, 2018, Arizona Governor Doug Ducey signed S.B. 1217 into law, creating a COBRA-like state continuation law (Arizona Mini-COBRA also known as Arizona COBRA).

Utah's Mini-COBRA Law. Utah's mini-COBRA law, as specified in 31A-22-722, provides continuation of group health insurance coverage for employees and their dependents in cases of qualifying events.

If the Qualifying Event is death of the covered employee, divorce or legal separation, or loss of dependent status, COBRA coverage is available for 36 months.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232