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  • Md Continuation Election Form

Get Md Continuation Election Form

MARYLAND CONTINUATION ELECTION FORM I wish to continue coverage under the Name of Company Employee Benefit Plan. I understand that this election is subject to the Plan. I have read and understand the MD Continuation Coverage Notice and the letter that accompanied this election form and both MD Continuation rights and limitations on those rights. YES NO IF YES PLEASE ATTACH A NEW APPLICATION Effective date of continuation coverage First payment is enclosed If first payment is not enclosed you will not be able to access health care coverage until payment is received* Qualifying Event Termination of Employment Death Divorce Type of Insurance Selected Health Dental Vision May not add lines of Insurance until Open Enrollment. Type of Coverage Selected Individual Husband/Wife Parent/Child Family Dependents may not be added until Open Enrollment unless a change in family status occurs. Signature Date Print Name Social Security Number Signature of Witness For Employer to complete Continuation ....

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Related content

Continuation Election Form - Maryland Insurance...
Before termination I was covered under the employer's group health insurance contract...
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cobra - United States Department of Labor
If you become entitled to elect COBRA continuation coverage when you otherwise would lose...
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D.C., Maryland, and Virginia all have mini-COBRA laws that apply to employers with fewer than 20 employees.

This is an opportunity to continue your current health coverage for typically up to 18 months at an increased personal cost, since you will be paying the portion your employer used to pay.

Length of Continuation Virginia regulations require continuation coverage for a period of 12 months from the date of loss of coverage.

Maryland State Continuation Maryland also has laws requiring insurers, nonprofit health service plans, and health maintenance organizations (HMOs) to offer continuation coverage to individuals who lose group membership through three events: involuntary termination of employment, death, or divorce.

Length of State Continuation Maryland regulations generally require continuation coverage for a period of 18 months from the date of loss of coverage. In cases of death or divorce, dependent children may continue coverage until the age when they would no longer qualify as dependents.

The Maryland mini-COBRA law provides for 18 months of continuation coverage, except in the case of terminations for cause. The employer is required provide an election form within 14 days of request by an employee.

Maryland Mini-COBRA Law Maryland's mini-COBRA law, also known as the Maryland Health Insurance Continuation Coverage Law, allows individuals who have lost their job and meet certain eligibility requirements to continue their group health insurance coverage. This coverage can last up to 18 months.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232