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  • Ameriflex Cobra Open Enrollment Form 2015

Get Ameriflex Cobra Open Enrollment Form 2015-2025

: APPLICANT COVERAGE Coverage: Add Remove Decline Plan Name: Medical Keep Same Dental Vision Rx SPOUSE COVERAGE Applicant Name Address (first, middle, last): (if different from applicant): City: State: Coverage: Add Remove Zip: Decline Plan Name: Medical Address Vision Rx Daughter (first, middle, last): (if different from applicant): City: State: Coverage: Add Remove Zip: Decline Plan Name: Medical Applicant Name SSN: DOB: Keep Same Dental DEPENDENT COVERAGE: So.

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Through your online account and Ameriflex mobile app, you can check your balance, reimburse yourself for out-of-pocket spending, check the status of a claim, set up direct deposit, and more.

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.

Open enrollment isn't just for your active employees. Your COBRA members also go through an open enrollment period each year.

There is no qualifying event that triggers offering COBRA when an employee makes a voluntary choice to drop dependents from the health insurance plan during open enrollment. Generally, COBRA requires that an employee, spouse or dependent child be covered by the plan the day prior to the qualifying event.

The COBRA rules require that employers provide qualified beneficiaries with the same open enrollment rights as similarly situated active employees. This means that qualified beneficiaries can change their health plan elections at open enrollment.

The rules allow for a qualified beneficiary who elected and paid for COBRA to add coverage for dependents under that plan at open enrollment. If the plan permits active employees to add new family members at times other than open enrollment, then qualified beneficiaries must be permitted as well.

Questions? To learn more about how you can easily manage your healthcare benefit account from your mobile phone, contact Ameriflex at 888.868. 3539 or visit myameriflex.com.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 requires employers with 20 or more employees who provide healthcare benefits to offer the option of continuing this coverage to individuals who would otherwise lose their benefits due to termination of employment.

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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