Continuation of Group Health Insurance Coverage Colorado Law 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Business Name and Group Number at the top of the form. This information is crucial for identifying your coverage.
3. Fill in the Business Address, Employee Name, Social Security Number, and Job Term Date. Ensure accuracy as this data is essential for processing your continuation request.
4. Indicate the effective termination date of your group health insurance coverage. This should be the last day of employment or when hours are reduced.
5. Specify your premium amounts for medical and dental coverage. Make sure to note that payments must be received by the designated date each month to avoid termination.
6. Select your continuation preference by checking the appropriate box and providing a signature along with the printed name and date.
7. Review all entries for completeness and accuracy before submitting. Use our platform’s features to save or print a copy for your records.

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