Get Ohio State Continuation Model Notice

Completing the Ohio State Continuation Model Notice is an essential step for individuals who wish to continue their health care coverage. This guide will provide clear and supportive instructions on how to fill out the form accurately and efficiently online.

Follow the steps to complete the Ohio State Continuation Model Notice online.

1. Click ‘Get Form’ button to obtain the form and open it in the editing platform.
2. Enter the date of the notice at the top of the form. It is crucial to have the correct date as it affects the timeline for election.
3. Identify the qualified beneficiary or beneficiaries by name or status in the designated area. This is important for confirming the individuals eligible for continuation coverage.
4. Read through the notice carefully to understand the rights and options regarding health care coverage.
5. In the Election Form section, mark the appropriate boxes to indicate if the loss of coverage was due to the end of employment and specify if it was involuntary or voluntary.
6. Complete the fields for names, dates of birth, relationship to the employee, and Social Security number or identifier for each qualified beneficiary.
7. Provide a signature and date at the bottom of the form to confirm your election for continuation coverage.
8. Finally, review the form for accuracy, save changes, download a copy, and share it with the relevant parties as required.

Complete your Ohio State Continuation Model Notice online today to ensure your health care coverage continues without interruption.