Get COBRA Form I

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, ...

The plan can set premium due dates for successive periods of coverage (after your initial payment), but it must give you the option to make monthly payments, and it must give you a 30-day grace period for payment of any premium.

This notice is intended to provide a summary of your rights, options, and notification responsibilities under COBRA. Should an actual qualifying event occur in the future and coverage is lost, the CalPERS will provide you (and your covered dependents, if any), with the appropriate COBRA election notice at that time.

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.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, ...

Voluntary or involuntary termination of the covered employee's employment for any reason other than gross misconduct. Reduction in the hours worked by the covered employee. Covered employee becoming entitled to Medicare. Divorce or legal separation from the covered employee.

COBRA Qualifying Event Notice The employer must notify the plan if the qualifying event is: Termination or reduction in hours of employment of the covered employee, • Death of the covered employee, • Covered employee becoming entitled to Medicare, or • Employer bankruptcy.

If you had job-based health coverage. Depending on the kind of job-based coverage you had (including COBRA or retiree coverage), you may get one of these from your employer or insurance company: Form 1095-B, Health Coverage. Form 1095-C, Employer-Provided Health Insurance Offer and Coverage.