Continuation Coverage Form With Employer

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

Description

The Continuation Coverage Form with Employer is essential for individuals electing COBRA continuation coverage, allowing them to maintain their health benefits after employment ends or other qualifying events. This form must be completed and returned within 60 days from the notification date. Users are instructed to provide their personal details, including names, dates of birth, relationships to the employee, and the specific coverage options selected. It is crucial for the form to be submitted through the specified method by the indicated due date to prevent losing the opportunity for COBRA coverage. Legal professionals such as attorneys, partners, owners, associates, paralegals, and legal assistants will find this form beneficial in guiding clients through their rights and responsibilities under federal law. It ensures clients understand the timelines and stipulations associated with their health coverage options. Additionally, the form includes an option to change minds before the due date, emphasizing the importance of timely submission for maintaining health benefits. Overall, this form serves as a critical tool for managing health insurance transitions and supporting users in navigating their rights effectively.
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  • Preview COBRA Continuation Coverage Election Form
  • Preview COBRA Continuation Coverage Election Form
  • Preview COBRA Continuation Coverage Election Form

How to fill out COBRA Continuation Coverage Election Form?

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FAQ

Written notification can either be sent to help@vitamail.com or mailed to 1451 Grant Road, #200, Mountain View, CA 94040. You can also cancel coverage over the phone by calling the Vita Concierge at (650) 966-1492.

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.

A person who elects COBRA can choose to cancel the coverage at any time (unlike active employee coverage, which can only be dropped during the employer's open enrollment period or during a special enrollment period linked to a qualifying life event).

Canceling COBRA coverage Enter a support request in the online message center. Send a letter to WageWorks requesting termination of your COBRA coverage (note that certain cancellation requests are subject to the employer's applicable group health plan provisions).

Continuation of benefits is possible when an employee is temporarily losing their benefits, such as a temporary or seasonal lay off or a leave of absence. With a continuation of benefits, the employee's group benefits remain in place with no lapse in coverage, provided premiums continue to be paid.

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Continuation Coverage Form With Employer