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  • Cobra Enrollment Form - Uha

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700 Bishop Street, Suite 300 Honolulu, HI 96813.4100 T 808.532.4007 F 877.222.3198 www.uhahealth.com Print Form Reset Form COBRA ENROLLMENT FORM Effective January 2014: The Monthly ACA Fee includes.

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Your former employer will send you details about how to sign up. Your employer has 30 days from this qualifying event to notify the COBRA administrator of your election. Keep in mind that if you wait to enroll, you won't save any money. COBRA is always retroactive to the day after your employer coverage ends.

COBRA coverage follows a "qualifying event". An example of a qualifying event would be if your hours were reduced or you lost your job (as long as there was no gross misconduct). Your employer must mail you the COBRA information and forms within 14 days after receiving notification of the qualifying event.

Open Enrollment The COBRA rules require that employers provide qualified beneficiaries with the same open enrollment rights as similarly situated active employees. This means that qualified beneficiaries can change their health plan elections at open enrollment.

Addition of New Dependents Adding a child or spouse may cause an increase in the amount you must pay for COBRA Continuation Coverage. Any Qualified Beneficiary can add a new spouse or child to his or her COBRA Continuation Coverage.

How long does it take for COBRA to kick in? With all paperwork properly submitted, your COBRA coverage should begin on the first day of your qualifying event (for example, the first day you are no longer with your employer), ensuring no gaps in your coverage.

To COBRA: Click on the “COBRA Installer” link above to download the installer. ... Locate the file “cobradotnetv4dot1.exe” on your computer and double-click to run the installer. Follow all on-screen instructions to complete the installation. To run COBRA, look for the “COBRA” entry in your “Start” menu.

How long does COBRA coverage last? Coverage starts on the day of the qualifying event and lasts for 36 months (18 months under federal COBRA and an additional 18 months if you qualify for Cal-COBRA) for you, your spouse, your registered domestic partner, and your dependent children.

COBRA coverage lets you pay to stay on your job-based health insurance for a limited time after your job ends (usually 18 months). You usually pay the full premium yourself, plus a small administrative fee. Contact your employer to learn about your COBRA options.

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© Copyright 1997-2025
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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
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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 workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
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