Get Cobra Notice

This guide provides a comprehensive overview of how to fill out the Cobra Election Notice online. It is designed to empower users, including those with limited legal experience, with clear and supportive instructions to ensure a successful completion of the form.

Follow the steps to complete your Cobra Notice online.

1. Click the ‘Get Form’ button to access the Cobra Notice and open it in your preferred digital editor.
2. Begin by filling in Section 1, Personal Information. Enter your TASC ID#, participant ID#, date of birth, full name, home address, and phone number. Make sure to indicate if there is an address change and if you are eligible for Medicare or another group health plan.
3. In Section 2, Spouse and Dependent Information, list the names, relationships, social security numbers, and dates of birth of dependents who are also electing coverage. Attach additional sheets if necessary.
4. Proceed to Section 3, Benefit Coverage Information. Review the benefits available to you. Note the COBRA start dates and monthly premiums to ensure accurate selection.
5. In Section 4, Continuation Election Information, clearly check the boxes to elect or decline each coverage option for you and your dependents. Ensure your choices reflect your preferred coverage.
6. Next, complete Section 5a for Participant Authorization by reading the notice of rights, signing to confirm your understanding and agreement, and providing the date. If declining coverage, use Section 5b for Declination Authorization.
7. After verifying all sections are complete and accurate, save your changes and print the form. Make sure to keep a copy for your records before you submit.
8. Finally, submit the completed Cobra Election Form to TASC by mailing, e-mailing, faxing, or hand-delivering it to the address provided. You may want to send it with your first premium payment, although it is not mandatory at this step.

Take the next step in managing your health coverage by completing the Cobra Notice online today.