California 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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FAQ

Key Takeaways. COBRA provides a good option for keeping your employer-sponsored health plan for a while after you leave your job. Although, the cost can be high. Make an informed choice by looking at all your options during the 60-day enrollment period, and don't focus on the premium alone.

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.

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.

The extension period is 18 months and some people with special qualifying events may be eligible for a longer extension. To be eligible for COBRA, your group policy must be in force with 20 or more employees covered on more than 50 percent of its typical business days in the previous calendar year.

If you want to avoid paying the COBRA cost, go with a short-term plan if you're waiting for approval on another health plan. Choose a Marketplace or independent plan for broader coverage. Choose a high-deductible plan to keep your costs low.

Qualified beneficiaries must be given an election period of at least 60 days during which each qualified beneficiary may choose whether to elect COBRA coverage. This period is measured from the later of the date of the qualifying event or the date the COBRA election notice is provided.

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.

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.

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California COBRA Continuation Coverage Election Form