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Cobra loophole 60 days

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The document is a COBRA Continuation Coverage Election Form that allows individuals to elect continuation coverage under a specific health plan. It outlines the process for completing and submitting the form, including a 60-day deadline for decision-making. The form requires personal information and coverage options for each individual electing coverage, and emphasizes the importance of timely submission to retain rights to COBRA coverage.

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Click ‘Get Form’ to open the COBRA Continuation Coverage Election Form in the editor.
Begin by entering your name, date of birth, and relationship to the employee in the designated fields.
Provide your Social Security Number (or other identifier) in the appropriate section.
Select your coverage option from the available choices listed on the form.
If you are electing coverage for additional individuals, repeat steps 2-4 for each person, ensuring all details are accurate.
Sign the form at the bottom, print your name, and indicate your relationship to those listed above.
Finally, enter your address and telephone number before submitting the completed form as instructed.

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