Get Arkansas State Group Continuation Coverage Election Form

The Arkansas State Group Continuation Coverage Election Form allows eligible individuals to continue their group health insurance coverage after employment termination. This guide provides step-by-step instructions for filling out the form online, ensuring you understand each section thoroughly.

Follow the steps to complete the form accurately online.

1. Press the ‘Get Form’ button to obtain the Arkansas State Group Continuation Coverage Election Form and open it in your preferred editing tool.
2. Begin by entering your name and ID number in the designated fields at the top of the form. Be sure to include your complete dependent name(s) if applicable.
3. Fill in the name of your former insurer and your previous employer’s details in the appropriate sections.
4. Enter your group number in the specified field. Ensure all information is accurate to avoid any issues with your continuation coverage.
5. Indicate your choice to continue coverage by checking the appropriate box. You have options for involuntary termination or simply expressing your desire to continue coverage.
6. Input the premium amount you need to pay each month to continue coverage, along with the start date of those payments.
7. Familiarize yourself with the conditions under which the continuation of coverage may terminate, as outlined in the document.
8. Sign the form where indicated, and include the date of your signature. If applicable, ensure the group administrator also signs and dates the form.
9. Once you have accurately filled out all sections of the form, ensure to save any changes made. You can now download, print, or share the completed form as needed.

Complete your Arkansas State Group Continuation Coverage Election Form online today to ensure your health coverage continues.