Get Cobra Continuation Coverage Form - The Culinary Health Fund

Completing the COBRA continuation coverage form for The Culinary Health Fund online is a straightforward process. This guide is designed to walk you through each section of the form in a clear and supportive manner.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to obtain the COBRA continuation coverage election form and open it in your preferred editor.
2. Begin by entering the details of each qualified beneficiary. For each person you wish to elect for COBRA coverage, provide their name, date of birth, relation to the employee, and Social Security number.
3. Next, select the type of coverage you wish to elect by checking only one option. The choices include CORE: Medical and Prescription Only or CORE PLUS: Medical, Dental, Vision, and Prescription. Remember to review the associated rates before making your selection.
4. Please note that if you, your spouse, or any dependent is eligible for Medicare, COBRA continuation coverage will serve as the secondary payer to Medicare. Be aware that COBRA coverage ends once Medicare becomes effective.
5. At the end of the form, sign and date it to certify your selections. Print your name and indicate your relationship to the beneficiaries listed.
6. Provide your contact information, including your telephone number and print address, to ensure The Culinary Health Fund can reach you if necessary.
7. Finally, send the completed election form to the Contribution Accounting Department at The Culinary Health Fund using the provided address before the due date.

Take action now and fill out your COBRA continuation coverage form online today!