Get Md Continuation Election Form
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How to fill out the MD Continuation Election Form online
The MD Continuation Election Form is an important document that allows users to continue their coverage under the Employee Benefit Plan. This guide will provide clear, step-by-step instructions for filling out the form online to ensure that all necessary information is accurately submitted.
Follow the steps to complete the MD Continuation Election Form online.
- Click the ‘Get Form’ button to obtain the form and open it for editing.
- Indicate your decision to continue coverage by selecting 'YES' or 'NO'. If you select 'YES', please attach a new application.
- Enter the effective date of your continuation coverage.
- Confirm whether your first payment is enclosed by selecting 'YES' or 'NO'. Note that if the first payment is not enclosed, you will not be able to access health care coverage until payment is received.
- Select the qualifying event that applies to your situation, such as 'Termination of Employment', 'Death', or 'Divorce'.
- Choose the type of insurance you are selecting: 'Health', 'Dental', or 'Vision'. Keep in mind that lines of insurance cannot be added until the Open Enrollment period.
- Select the type of coverage you want: 'Individual', 'Husband/Wife', 'Parent/Child', or 'Family'. Note that dependents cannot be added until the Open Enrollment period unless there is a change in family status.
- Sign and date the form where indicated. This includes printing your name and entering your Social Security Number.
- If required, have a witness sign the form in the designated area.
- For employer completion, ensure the continuation coverage end date is filled out, billing details are included, and the appropriate billing address is provided.
- After completing all sections, review the form for accuracy, then save changes, download, print, or share the completed form as needed.
Complete your MD Continuation Election Form online today to ensure your coverage continues without interruption.
D.C., Maryland, and Virginia all have mini-COBRA laws that apply to employers with fewer than 20 employees.
Fill MD Continuation Election Form
Date of Application: Signature of Insured: Mailing Address: This selection form is for continued group coverage in accordance with Maryland statute and regulations. Participating Qualified Beneficiaries must submit a signed election form for continuation coverage within the 45-day period following the qualifying event date. Find step-by-step guidance on filling out the Maryland Continuation Election form, making the process simple and efficient for residents. If you choose to elect continuation coverage, you don't have to send any payment with the Election Form. (2) The election period for continuation coverage under this section begins on the date of the death of the insured and ends at least 45 days after that date. The covered employee must submit an election form within 45 days of an employment termination or 60 days following a divorce. To elect continuation coverage, follow the instructions on the following pages to complete the enclosed. Indicate if you wish to continue medical insurance for yourself. You must elect single coverage to elect continuation of dependent coverage.
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