Get Cobra Election Form Aef-cobra2 11/05

What is COBRA? COBRA stands for Consolidated Omnibus Budget Reconciliation Act of 1985. It allows you and/or your dependents to continue the health and optional insurance coverage (dental and vision) you have through the Texas Employees Group Benefits Program (GBP) for a specified period after you leave employment.

COBRA requires that continuation coverage extend from the date of the qualifying event for a limited period of 18 or 36 months. The length of time for which continuation coverage must be made available (the “maximum period” of continuation coverage) depends on the type of qualifying event.

Form 1095-C, Part II, line 15 enter COBRA premium for the lowest-cost self-only coverage providing minimum value offered. Form 1095-C, Part II, line 16 enter Code 2C. If self-insured, complete Form 1095-C, Part III for all enrolled individuals and in column (e) check applicable months that COBRA coverage was elected.

The three ways to pay COBRA premiums are through ACH (linked to your bank account), credit/debit card or check. We recommend paying by ACH.

Employers should send notices by first-class mail, obtain a certificate of mailing from the post office, and keep a log of letters sent. Certified mailing should be avoided, as a returned receipt with no delivery acceptance signature proves the participant did not receive the required notice.

Qualifying Event: At the end of your employment or because of reduction of hours (not maintain full-time status) you will receive this letter. It is VERY important that you review this letter and make your decision if you will need to continue your coverage through COBRA.

Q8: How long do I have to elect COBRA coverage? If you are entitled to elect COBRA coverage, you must be given an election period of at least 60 days (starting on the later of the date you are furnished the election notice or the date you would lose coverage) to choose whether or not to elect continuation coverage.