Home
Forms Library
Anthem blue cross cobra

Get the up-to-date COBRA or State Continuation of Coverage Application - Anthem 2025 now

anthem blue cross cobra Preview on Page 1

Show details

4 out of 5

45 votes

The document is a COBRA and State Continuation of Coverage application form for employees and their dependents to apply for the continuation of medical, dental, or vision benefits after employment termination or qualifying events. It outlines eligibility, required information, payment details, and the rights of employees and dependents regarding coverage duration and conditions.

Here's how it works

01. Edit your anthem blue cross cobra online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send anthem cobra via email, link, or fax. You can also download it, export it or print it out.

How to edit COBRA or State Continuation of Coverage Application - Anthem online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making adjustments to your paperwork takes just a few simple clicks. Follow these fast steps to edit the PDF COBRA or State Continuation of Coverage Application - Anthem online free of charge:

Sign up and log in to your account. Sign in to the editor using your credentials or click on Create free account to test the tool’s functionality.
Add the COBRA or State Continuation of Coverage Application - Anthem for redacting. Click on the New Document button above, then drag and drop the document to the upload area, import it from the cloud, or via a link.
Change your document. Make any adjustments needed: add text and images to your COBRA or State Continuation of Coverage Application - Anthem, highlight details that matter, remove parts of content and substitute them with new ones, and add symbols, checkmarks, and fields for filling out.
Finish redacting the form. Save the updated document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is very easy to use and effective. Try it out now!

See more COBRA or State Continuation of Coverage Application - Anthem versions

We've got more versions of the COBRA or State Continuation of Coverage Application - Anthem form. Select the right COBRA or State Continuation of Coverage Application - Anthem version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2003	4 Satisfied (45 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the continuation period for COBRA?

You can collect COBRA benefits for up to 18 months. This may be extended to 36 months under certain circumstances. If your employer has 20 or more employees, it must follow COBRA rules.

What are the qualifying events for COBRA continuation coverage?

COBRA coverage follows a qualifying event. An example of a qualifying event would be if your hours were reduced or you lost your job (as long as there was no gross misconduct). Your employer must mail you the COBRA information and forms within 14 days after receiving notification of the qualifying event.

Is COBRA the same as state continuation?

Californias state continuation is called Cal-COBRA.

What is state continuation vs COBRA?

In California, the state continuation rule is referred to as Cal-COBRA and allows enrollees to continue their coverage for between 18 and 36 months, depending on the qualifying event that would have otherwise ended their healthcare coverage. Coverage can also be extended for qualifying family members.

What is a continuation COBRA?

COBRA continuation coverage will ensure you have health coverage until the coverage through your Marketplace plan begins. Through the Marketplace you can also learn if you qualify for free or low-cost coverage from Medicaid or the Childrens Health Insurance Program (CHIP).

What is COBRA in simple terms?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss,

Get the up-to-date COBRA or State Continuation of Coverage Application - Anthem 2025 now

Here's how it works

How to edit COBRA or State Continuation of Coverage Application - Anthem online