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How to use or fill out Consolidated Omnibus Budget Reconciliation Act 'COBRA' PERS-HBD-85 (Rev 10/17) with our platform
- Click ‘Get Form’ to open it in the editor.
- In Part A, select the type of action: check 'NEW' for a new enrollment or 'CHANGE' if you are modifying existing coverage. Specify the qualifying event and its date.
- In Part B, fill in the COBRA enrollee's information, including name, address, and social security number. If applicable, identify the subscriber.
- Part C requires you to provide the name and address of your health plan. Ensure that you continue with the same coverage as before unless changing during Open Enrollment.
- In Part D, list all family members to be enrolled. Use action codes 'A' for adding and 'D' for deleting individuals from coverage.
- Complete Part F by signing and dating the form to confirm your agreement to pay premiums directly to the carrier.
- Finally, ensure that Parts G is filled out by your agency's health benefits officer after submission.
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You can easily edit fill out your Consolidated Omnibus Budget Reconciliation Act "COBRA" PERS-HBD-85 (Rev 10/17). Consolidated Omnibus Budget Reconciliation Act "COBRA" PERS-HBD-85 (Rev 10/17) on any iOS gadget. Open an internet browser of your liking, visit the DocHub website, authorize or create a new account, upload your file for editing, and make your required adjustments. Our service is mobile-friendly, so utilizing its features on your phone will be a no-brainer, even on the first try.
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