Notice to Medical Insurance Provider of Request for Continuation Coverage - Minnesota: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by entering your full name in the designated field, ensuring accuracy as this identifies you as the requester.
Next, input the full name of your former spouse in the appropriate section. This is crucial for linking your request to their health plan.
Fill in the date before your divorce when you were covered under the group health plan. This establishes your eligibility for continuation coverage.
In the section regarding the group health plan, provide its full name and address. This information is necessary for proper communication with the insurance provider.
Referencing the attached legal documents, include the date of decree signed and case details accurately to support your request.
Finally, sign and date the form at the bottom. Ensure that all fields are completed before submitting to avoid delays.

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What is a continuation of coverage?

Continuation coverage allows someone who recently lost their employer-based health coverage to continue their current insurance policy as long as they pay the full monthly premiums. Continuation coverage falls into four categories: COBRA, Cal-COBRA, Conversion, and HIPAA.

What is the continuation timeline for Cobra?

18 months: For the employee and covered dependents in the case of termination of employment or reduction in hours. 29 months: For the employee and covered dependents in the case of disability in the first 60 days of COBRA enrollment.

What is MN continuation?

Both federal COBRA and Minnesota continuation allow individuals (qualified beneficiaries) to continue benefits after a qualifying event, including: Termination of employment (voluntary or involuntary). Divorce/separation. Death of an employee. Dependent losing eligibility.

What are COBRAs downsides?

High Cost. The most docHub downside of COBRA is the cost. Youre responsible for the full premium, including what your employer used to pay, plus a 2% administrative fee. This can make COBRA docHubly more expensive than what you were used to paying while employed.