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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.
Start filling out your COBRA forms online for free today!
The COBRA insurance form should be sent to you by the employers human resources department, or the company may have hired a third-party administrator to manage the COBRA benefits enrollment.
Where do I get COBRA paperwork?
Depending on the kind of job-based coverage you had (including COBRA or retiree coverage), you may get one of these from your employer or insurance company: Form 1095-B, Health Coverage. Form 1095-C, Employer-Provided Health Insurance Offer and Coverage.
What does COBRA stand for?
First, you should contact your former employers human resources department to request a new copy of the paperwork. They may be able to send it to you electronically or by mail. If you are unable to obtain a new copy from your former employer, you can also contact the COBRA administrator for your health plan.
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The American Rescue Plan Act of 2021 Part 1, COBRA
Mar 12, 2021 Below is an overview of the Consolidated Omnibus Budget. Reconciliation Act (COBRA) coverage premium assistance provisions contained in the Act.
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