Rhode Island COBRA Continuation Coverage Election Form

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

This form allows an individual to elect COBRA continuation coverage.
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FAQ

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.

You can apply for Individual and Family coverage at HealthSource RI by visiting or by calling 1-2010855-2010840-20104774. You can also learn more about Medicaid and RIte Care by contacting the Rhode Island Department of Human Services at 1-2010855-2010574-20102856 or by visiting EOHHS.RI.gov.

Q13: Can I extend my COBRA continuation coverage? If you are entitled to an 18 month maximum period of continuation coverage, you may become eligible for an extension of the maximum time period in two circumstances.

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.

You can apply for Marketplace coverage at HealthCare.gov or by calling 1-800-318- 2596 (TTY 1-855-889-4325). To qualify for special enrollment in a Marketplace plan, you must select a plan within 60 days before or 60 days after losing your job-based 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.

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.

COBRA is always effective the day after your active coverage ends. For most, active coverage terminates at the end of a month and COBRA is effective on the first day of the next month.

Insured group hospital, surgical, dental, vision, or medical insurance plans must provide up to 18 months' continuation coverage to individuals who would otherwise lose coverage because of an involuntary layoff, a workplace ceasing to exist, a permanent reduction in size of the workforce, or the death of an employee (

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Rhode Island COBRA Continuation Coverage Election Form