Continuation Coverage Form For Cobra Coverage
Description
How to fill out COBRA Continuation Coverage Election Form?
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FAQ
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.
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.
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.
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.
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.