Get 11 Small Group Information Change Form

Filling out the 11 Small Group Information Change Form is an important step for employers needing to update employee and dependent information related to COBRA and other changes. This guide provides clear, step-by-step instructions to assist you in completing the form online efficiently.

Follow the steps to successfully complete the form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor, allowing you to start filling it out online.
2. Begin with Section 1, which requires you to input the employer information. Fill in the employer name, group or case number, and the name, email address, and phone number of the person completing the form.
3. In Section 2, titled 'Terminating employees', provide information about terminating employees. Include the social security number or ID number, employee's name, date of birth, and termination date.
4. Indicate whether the employee is eligible for Cal-COBRA or Federal COBRA by checking the appropriate boxes. Ensure you follow the COBRA guidelines if applicable.
5. If a dependent is cancelling their coverage, fill in their details under this section and check the relevant boxes for their coverage.
6. In Section 3, complete the change of address information, if applicable. Fill in the new address details for either the employee or employer as required.
7. Review all entered information for accuracy and completeness. Make sure to check for any required forms or attachments in compliance with the rules regarding COBRA.
8. After ensuring all sections are accurately filled out, save your changes. You can then download, print, or share the completed form as necessary.

Start completing the 11 Small Group Information Change Form online today to ensure your employee information is up to date.