R the date of this notice to decide whether you want to elect COBRA continuation coverage under the Plan. Send completed Election Form to: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ This Election Form must be completed and returned by mail or hand delivery on ________________________________. If mailed, it must be post-m.
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How to fill out the MKT-365 online
The MKT-365 form is essential for electing COBRA continuation coverage. This guide provides comprehensive instructions to help you easily navigate the online form, ensuring you complete it correctly and efficiently.
Follow the steps to successfully complete the MKT-365 form.
- Press the ‘Get Form’ button to access the MKT-365 form. This will open the document for you to fill out.
- Begin by providing personal information for each person you wish to include in your COBRA coverage. Enter each individual's last name, first name, middle initial, date of birth (MM/DD/YYYY), social security number, and their relationship to the employee.
- Indicate the type of group health plans that you are electing for COBRA continuation coverage by checking the appropriate boxes. You can choose health coverage, dental coverage, or both.
- Select the type of coverage you wish to continue by checking only one of the following options: family coverage, single coverage, or decline/waive your right to COBRA continuation coverage.
- Once all sections are completed, review your information for accuracy. Then, provide your signature, print your name, and enter the current date.
- Complete the form by entering your contact details, including your address and telephone number.
- After finalizing all information, save your changes. You may also download, print, or share the form as needed. Ensure that the completed Election Form is submitted by the specified due date.
Take action now and complete your MKT-365 form online to ensure your COBRA coverage.
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