Get Md Continuation Election Form

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.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Indicate your decision to continue coverage by selecting 'YES' or 'NO'. If you select 'YES', please attach a new application.
3. Enter the effective date of your continuation coverage.
4. 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.
5. Select the qualifying event that applies to your situation, such as 'Termination of Employment', 'Death', or 'Divorce'.
6. 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.
7. 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.
8. Sign and date the form where indicated. This includes printing your name and entering your Social Security Number.
9. If required, have a witness sign the form in the designated area.
10. For employer completion, ensure the continuation coverage end date is filled out, billing details are included, and the appropriate billing address is provided.
11. 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.