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- Click ‘Get Form’ to open the COBRA Continuation Coverage Election Form in the editor.
- Begin by entering your name, date of birth, and relationship to the employee in the designated fields. Ensure accuracy as this information is crucial for processing your election.
- Provide your Social Security Number (or other identifier) in the appropriate section. This helps verify your identity and eligibility for coverage.
- Select the coverage option you wish to elect from the available choices. If applicable, repeat this process for additional individuals by filling out their respective details.
- Once all necessary fields are completed, sign the form electronically. Include your printed name, relationship to those listed, address, and telephone number.
- Review all entered information for accuracy before submitting. You can easily make edits using our platform if needed.
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