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Consolidated Omnibus Budget Reconciliation Act "COBRA" PERS-HBD-85 (Rev 10/17). Consolidated Omnibus Budget Reconciliation Act "COBRA" PERS-HBD-85 (Rev 10/17)

17) 2025

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4.3 out of 5

178 votes

The document provides instructions for completing the COBRA enrollment form (PERS-HBD-85) for health coverage continuation under the Consolidated Omnibus Budget Reconciliation Act. It outlines the necessary information required from enrollees, including qualifying events, personal details, and health plan information. Additionally, it emphasizes the importance of timely reporting of enrollment changes and includes privacy information regarding the handling of personal data.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (45 Votes)
2018	4.3 Satisfied (178 Votes)
2013	4.3 Satisfied (72 Votes)

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