Arizona COBRA Continuation Coverage Election Form

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State:
Multi-State
Control #:
US-322EM
Format:
Word; 
Rich Text
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Description

This form allows an individual to elect COBRA continuation coverage.
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How to fill out COBRA Continuation Coverage Election Form?

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FAQ

Cal-COBRA is a California Law that lets you keep your group health plan when your job ends or your hours are cut. It may also be available to people who have exhausted their Federal COBRA.

COBRA continuation coverage lets you stay on your employer's group health insurance plan after leaving your job. COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It's shorthand for the law change that required employers to extend temporary group health insurance to departing employees.

The following are qualifying events: the death of the covered employee; a covered employee's termination of employment or reduction of the hours of employment; the covered employee becoming entitled to Medicare; divorce or legal separation from the covered employee; or a dependent child ceasing to be a dependent under

Your COBRA coverage will begin at the full premium amount. Payment must be received within 45 days after the enrollment form has been received. COBRA will begin the day after active coverage ends. COBRA COVERAGE WILL NOT BEGIN UNTIL PAYMENT IS RECEIVED.

The general notice describes general COBRA rights and employee obligations. This notice must be provided to each covered employee and each covered spouse of an employee who becomes covered under the plan. The notice must be provided within the first 90 days of coverage under the group health plan.

Federal law requires that most group health plans (including this Plan) give employees and their families the opportunity to continue their health care coverage through COBRA continuation coverage when there's a qualifying event that would result in a loss of coverage under an employer's plan.

COBRA the Consolidated Omnibus Budget Reconciliation Act -- requires group health plans to offer continuation coverage to covered employees, former employees, spouses, former spouses, and dependent children when group health coverage would otherwise be lost due to certain events.

There are several other scenarios that may explain why you received a COBRA continuation notice even if you've been in your current position for a long time: You may be enrolled in a new plan annually and, therefore, receive a notice each year. Your employer may have just begun offering a health insurance plan.

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Arizona COBRA Continuation Coverage Election Form