Get Connecticut Continuation Coverage Election Notice Fillable Form

Filling out the Connecticut Continuation Coverage Election Notice Fillable Form is an essential step for users seeking to maintain their health care coverage after a qualifying event. This guide provides clear instructions on how to effectively complete the form online to ensure you and your qualified beneficiaries can elect COBRA continuation coverage without any issues.

Follow the steps to complete the form online

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. Identify the sections to fill out, starting with the recipient's name(s) and date. This information should be entered clearly to avoid delays in processing.
3. Next, indicate the type of qualifying event that has resulted in the need for continuation coverage. Check the applicable box next to items such as 'End of employment' or 'Divorce or legal separation'.
4. List each qualified beneficiary's information, including full name, date of birth, relationship to the employee, and Social Security number or another identifier in the provided fields.
5. Select and mark the coverage options you wish to elect by checking the appropriate options for health, dental, or vision coverage. Ensure to make clear selections to avoid confusion.
6. Provide your signature and the date to verify the information provided on the form is accurate. This is an essential part of the process to validate your election.
7. Lastly, save the completed form, then proceed to print it if necessary. You can also download a copy for your records, and be sure to submit the form according to the instructions before the deadline.

Start completing your forms online today to secure your health care coverage!