Get Il State Continuation Coverage Election Notice 2020-2026

The IL State Continuation Coverage Election Notice provides vital information about your right to continue your health care coverage after a qualifying event. By completing this notice online, you will ensure minimal disruption to your health care benefits.

Follow the steps to fill out the form correctly and effectively.

1. Click ‘Get Form’ button to access the IL State Continuation Coverage Election Notice and open it for editing.
2. Begin by entering the date of the notice at the top of the form. This date is important for tracking the timeline of your election period.
3. Identify the qualified beneficiary or beneficiaries by listing their names under the specified section. Ensure that the information is accurate and complete.
4. Indicate the reason for termination by checking the appropriate box. Be thorough while describing any events that led to the loss of coverage.
5. Check the relevant category or categories of qualified beneficiaries entitled to elect continuation coverage. The categories include employee, spouse, and dependent child(ren).
6. Fill in the required details for each individual eligible for continuation coverage, including their name, date of birth, relationship to the employee, and social security number or other identifier.
7. Sign and date the form to confirm your commitment to elect continuation coverage. Include your printed address and telephone number.
8. After completing the form, review all entries for accuracy. Save any changes and download the filled form for your records.
9. Submit the completed Election Form as instructed, ensuring it is sent to the designated contact handling continuation coverage within the required timeframe.

Complete the IL State Continuation Coverage Election Notice online to ensure your health care coverage is uninterrupted.