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  • Kaiser Cobra Form - Filice

Get Kaiser Cobra Form - Filice

Submitting this form. Retain a copy for your records and to use as a temporary ID card if you are a new Kaiser Permanente member. Employer Group Coverage Information Please complete the following information so we will know about your employer s account with us. The employer from which you originally obtained COBRA should be used regardless of your current employer/employment status. Purchaser/Enrollment Unit Number (Your employer can provide this to you.) Employer Employee name (Last/First/.

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Cal-COBRA Required Notices The California Continuation Benefits Replacement Act of 1997 (Cal-COBRA) requires that certain notices about coverage be provided to insurance carriers and employees at certain times.

You may be able to keep your job-based health plan through COBRA continuation coverage. COBRA coverage lets you pay to stay on your job-based health insurance for a limited time after your job ends (usually 18 months). You usually pay the full premium yourself, plus a small administrative fee.

Usually, consumers have until the later of 60 days after losing eligibility for their employer's group health coverage or 60 days after receiving their COBRA election notice, whichever is later, to elect COBRA continuation coverage. ➢ Consumers have 45 days after election to pay their first month's premium.

There are three basic requirements that must be met in order for you to be entitled to elect COBRA continuation coverage: Your group health plan must be covered by COBRA; • A qualifying event must occur; and • You must be a qualified beneficiary for that event.

Kaiser Permanente billed federal COBRA and Cal-COBRA Kaiser Permanente bills members directly for federal COBRA health coverage and any Cal-COBRA mandated coverage. The employer's Cal-COBRA population is individuals who have exhausted all 18 months of federal COBRA and qualify for Cal-COBRA.

Federal COBRA is a federal law that lets you keep your group health plan when your job ends or your hours are cut. Federal COBRA requires continuation coverage be offered to covered employees, their spouses, former spouses, and dependent children.

Cal-COBRA is a California Law that lets you keep your group health plan when your job ends or your hours are cut. It may also be available to people who have exhausted their Federal COBRA.

Federal COBRA generally extends health coverage for 18 months. Individuals with certain qualifying events may be eligible for a longer extension (e.g., 29 or 36 months). Cal-COBRA allows individuals to continue their group health coverage for up to 36 months.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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