Cobra Coverage Application Without Insurance

Category:
State:
Multi-State
Control #:
US-322EM
Format:
Word; 
Rich Text
Instant download

Description

The COBRA Continuation Coverage Election Form is designed for individuals who wish to elect COBRA continuation coverage when they lose their group health insurance. To complete the form, users must fill in personal details such as name, date of birth, relationship to the employee, and social security number (or other identifier), along with their elected coverage options. It is crucial to return this form within 60 days of receipt to retain the right to COBRA coverage. Users who initially reject coverage can later elect it if they submit the completed form by the deadline. This form includes instructions for mailing and emphasizes the importance of timely submission. The form is particularly useful for attorneys, partners, owners, associates, paralegals, and legal assistants who are assisting clients with health coverage matters. It provides a clear structure for data collection and ensures users understand their rights regarding health insurance continuation.
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How to fill out COBRA Continuation Coverage Election Form?

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FAQ

The three ways to pay COBRA premiums are through ACH (linked to your bank account), credit/debit card or check. We recommend paying by ACH.

You can also make a one-time payment in your online account. For more information, see How to make a one-time COBRA premium payment in your online account. You also have the option to log in to the COBRA Mobile App to make a one-time or recurring payment.

To access the COBRA portal, click on the Login button in the upper right hand corner of the website, then click "Members" from the dropdown menu. From the Member Login page, click the "COBRA Login" button and you will be directed to the COBRA portal page.

The plan must allow qualified beneficiaries to pay the required premiums on a monthly basis if they ask to do so, and may allow payments at other intervals (for example, weekly or quarterly). Plans cannot require qualified beneficiaries to pay a premium when they make the COBRA election.

If you get COBRA, you must pay for the entire premium, including any portion that your employer may have paid in the past. This means your payment is often more expensive than what you paid as an employee. You can collect COBRA benefits for up to 18 months. This may be extended to 36 months under certain circumstances.

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Cobra Coverage Application Without Insurance