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CalPERS Group Continuation Coverage (COBRA) CalPERS Group Continuation Coverage (COBRA) - calpers ca

CalPERS Group Continuation Coverage (COBRA) CalPERS Group Continuation Coverage (COBRA) - calpers ca 2025

CalPERS Group Continuation Coverage (COBRA) CalPERS Group Continuation Coverage (COBRA) - calpers ca Preview on Page 1

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The document provides instructions for completing the Group Continuation Coverage form under the Consolidated Omnibus Budget Reconciliation Act (COBRA) for the Public Employees' Retirement System. It outlines the necessary information required from enrollees, including details about qualifying events, enrollee and dependent information, health plan carrier details, and enrollment changes. The document emphasizes the importance of timely reporting of changes and includes privacy information regarding data collection.

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Click ‘Get Form’ to open it in the editor.
In Part A, select the type of action: 'NEW' for new enrollment or 'CHANGE' for modifications. Fill in the qualifying event and its date.
Proceed to Part B. Enter the COBRA enrollee's information, including name, address, and Social Security number. If applicable, identify the subscriber.
In Part C, specify the health plan carrier's name and contact details. Ensure you maintain the same coverage as before unless during an Open Enrollment period.
For Part D, list all family members to be enrolled. Use action codes 'A' for adding and 'D' for deleting individuals from coverage.
Complete Parts E and F by providing any necessary prior health plan information and signing where indicated.

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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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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 difference between COBRA and cal COBRA?

If an employee loses his or her job, COBRA allows the employee to continue to be in the employers group health plan, usually at the full cost of the premium (with no employer contribution), and with an administrative fee added.

How much is a CalPERS COBRA?

COBRA premiums are calculated at 102% of the Basic premiums, but some carriers may charge less than these maximum amounts.

What is a CalPERS COBRA?

The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to continue health coverage for yourself and your dependents if you involuntarily lose your health benefits. Coverage must be continuous and youll be required to pay premiums from the date your CalPERS coverage ended.

How long does a COBRA last after you retire?

If you get COBRA, you must pay for the entire premium, including any portion that your employer may have paid in the past. This means your payment is often more expensive than what you paid as an employee. You can collect COBRA benefits for up to 18 months. This may be extended to 36 months under certain circumstances.