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  • Ameriflex Cobra Request For Service 2015

Get Ameriflex Cobra Request For Service 2015-2025

ADDRESS CHANGE IF APPLICABLE. New Address: City: State: Zip: Add/Drop Dependent (Check One): Add* Drop. Dependent Name: Dependent D.O.B.:.

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Applying for COBRA begins with the employer who provided the health plan to notify you of your right to continuation. The employer has 30 days to notify the group health plan of the qualifying event. After that, the employer has 14 days to notify you of your COBRA right to keep your work health insurance.

COBRA only applies to FSAs which are said to be underspent. * This means that the amount available for reimbursement for the remainder of the plan year exceeds the COBRA premium for that same time period. Figuring out if the FSA is underspent involves a bit of math, so it's best illustrated with an example.

To cancel COBRA: Download and fill out our COBRA Request for Service Form. When filling out the form, indicate that you would like to Drop Coverage for the primary account holder as well as dependents, or use the appropriate fields to indicate the specific family members for who you would like to cancel coverage.

There are three ways to do so: Terminate coverage on your online account. For instructions, see How to terminate coverage in your COBRA online account. Submit a completed COBRA Benefits Termination Form. Do not remit the premium payment for the month you no longer want coverage.

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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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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