Cobra form i get 2026

1. Click ‘Get Form’ to open the COBRA Coverage Election Form in the editor.
2. Begin by filling in your personal information. Enter your name, home address, date of birth, and social security number in the designated fields.
3. Indicate your marital status by checking either 'Single' or 'Married'. Also, provide the policy number associated with your health plan.
4. In the section regarding entitlement to COBRA coverage, check the appropriate box that applies to your situation: termination of employment or reduction in hours.
5. List all qualified beneficiaries who are entitled to elect COBRA continuation coverage. Ensure you include their names, dates of birth, and relationships to you.
6. Select the health insurance plan you wish to continue coverage for by checking the corresponding box and providing any additional required details.
7. Finally, review the form for accuracy, sign it, and enter the date before submitting it as instructed.

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