Cobra Election Form Example

• Category: Employment - Cobra
• State: Multi-State
• Control #: US-322EM
• Format: Word; Rich Text

Description

The COBRA Continuation Coverage Election Form is a crucial document for individuals seeking to maintain health insurance coverage after leaving their job or experiencing a qualifying event. This form must be completed and submitted within 60 days from the notice date to secure COBRA coverage. Key features include sections for personal information such as name, date of birth, relationship to the employee, Social Security number, and the elected coverage option. Users must fill out the form thoroughly and submit it via mail or other specified means by the deadline. If an individual initially rejects coverage, they may still opt in later if the election form is submitted on time. This form provides vital information regarding rights associated with COBRA coverage. The targeted audience, including attorneys, partners, owners, associates, paralegals, and legal assistants, can utilize this form to advise clients on their rights and responsibilities concerning health insurance after employment. Legal professionals can facilitate the completion of this form, ensuring that individuals understand their options and adhere to submission deadlines to avoid losing coverage.