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  • Cal-cobra Enrollment Request Form - Mhn

Get Cal-cobra Enrollment Request Form - Mhn

Fits. Mail to: Managed Health Network Attn: Membership Accounting Cal-COBRA 1600 Los Gamos Drive, Suite 300 San Rafael, CA 94903 Name (last, first, middle initial): Current Member ID Number (if available): Former Employer: Address: Date of Birth:.

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Employers should ensure that a Cal-COBRA General Notice is provided to all eligible group health care participants and their qualified beneficiaries within 90 days of becoming eligible to participate in the group health plan.

Certain events, such as layoffs, death and divorce, trigger eligibility for COBRA or CalCOBRA. The plan administrator must notify the employee and his/her covered spouse of their right to continue coverage within 44 days of the event, except during a legal separation or divorce.

All employers are responsible for administering their own federal COBRA program. Blue Shield administers Cal-COBRA when an employer is subject to it under state law. Groups have the option to self-administer their federal COBRA benefits.

Personnel staff are usually notified when a covered employee has died, voluntarily or involuntarily terminated employment, or reduced hours.

Your employer must mail you the COBRA information and forms within 14 days after receiving notification of the qualifying event. You are responsible for making sure your COBRA coverage goes into and stays in effect - if you do not ask for COBRA coverage before the deadline, you may lose your right to COBRA coverage.

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.

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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