Illinois COBRA Continuation Coverage Election Form

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

This form allows an individual to elect COBRA continuation coverage.

The Illinois COBRA Continuation Coverage Election Form is an essential document that provides information and instructions for individuals who have experienced a qualifying event and wish to continue their health insurance coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA allows employees and their dependents to maintain their health insurance coverage temporarily after experiencing certain life events, such as job loss, reduction in work hours, or divorce. The Illinois COBRA Continuation Coverage Election Form is specifically designed for residents of Illinois who have been covered under an employer-sponsored group health plan. This form is crucial as it outlines the process and necessary steps to enroll in COBRA continuation coverage, ensuring that individuals have access to vital healthcare services. This comprehensive form includes various sections that require accurate and up-to-date information from the individual, such as their name, address, contact details, and the qualifying event that makes them eligible for COBRA coverage. Additionally, the form may request information about the employer and the group health plan, including the name of the plan, the employer's contact information, and the coverage start and end dates. It is important to note that there may be different types of Illinois COBRA Continuation Coverage Election Forms, depending on the specific circumstances and coverage options available. Some potential variations of the form could include: 1. Illinois COBRA Continuation Coverage Election Form for Employees: This form is for employees who have experienced a qualifying event that has resulted in the loss of employer-sponsored health insurance coverage. It allows them to select and enroll in the COBRA continuation coverage. 2. Illinois COBRA Continuation Coverage Election Form for Spouses and Dependents: This form is intended for spouses and dependents of individuals who have experienced a qualifying event. It enables them to choose whether they want to continue their health insurance coverage under COBRA. 3. Illinois COBRA Continuation Coverage Election Form for Divorced or Separated Individuals: This form caters to individuals who have gone through a divorce or legal separation from the covered employee. It provides them with the option to maintain their health insurance coverage through COBRA. In conclusion, the Illinois COBRA Continuation Coverage Election Form plays a crucial role in facilitating the process of obtaining COBRA continuation coverage. By providing detailed and accurate information, individuals can ensure seamless access to continued healthcare services during transitional periods in their lives.

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FAQ

Under COBRA, an individual may be entitled to up to 18 months, 29 months, or 36 months of continuation coverage depending upon which qualifying event(s) triggered the COBRA coverage.

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.

Illinois Continuation (mini-COBRA) must be offered to you and your eligible dependents who were continuously covered under the group policy for three months prior to termination of employment or reduction in hours below the minimum required by the group plan.

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 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 Consolidated Omnibus Budget Reconciliation Act (COBRA) provides eligible covered members and their eligible dependents the opportunity to temporarily extend their health coverage when coverage under the health plan would otherwise end due to certain qualifying event.

More info

Your past-due payments will be returned, and your COBRA coverage will be canceled. See the COBRA election notice for payment mailing instructions. ARE THERE ...4 pages Your past-due payments will be returned, and your COBRA coverage will be canceled. See the COBRA election notice for payment mailing instructions. ARE THERE ... Coverage. To assist you, here are instructions for completing these forms: COBRA Notice of Continuation ("Notice"). ? This Notice should be completed by the ...6 pagesMissing: Illinois ? Must include: Illinois coverage. To assist you, here are instructions for completing these forms: COBRA Notice of Continuation ("Notice"). ? This Notice should be completed by the ...Each qualified beneficiary may independently elect COBRA continuation coverage. You must notify the plan administrator of election of COBRA coverage within 60 ... For more information or to file a complaint, visit our website or contact:Wisconsin's continuation law applies to most group health insurance policies ...4 pages For more information or to file a complaint, visit our website or contact:Wisconsin's continuation law applies to most group health insurance policies ... Their health care coverage where there is a ?qualifying event? that would resultTo elect continuation coverage, you must complete the election form and ... Instructions: To choose Illinois Municipality Continuation Coverage, complete this Election Form and return it to Health. Alliance at the address listed ... A. No policy of group accident or health insurance, nor any certificate thereunder shall be delivered(i) a form for election to continue the insurance ... If you qualified for COBRA continuation coverage because you or a household member had a reduction in work hours or involuntarily lost a job, you may have ... The Group Health coverage under which you have been covered will ceasecomplete the Request/Refusal Statement on the reverse side of this form and ... This COBRA GENERAL NOTICE contains important information and instructions regarding your health benefits continuation coverage under COBRA.

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Illinois COBRA Continuation Coverage Election Form