Cobra Application Form - SuperAgent 2025

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You have 60 days to enroll in COBRA once your employer-sponsored benefits end. Even if your enrollment is delayed, you will be covered by COBRA starting the day your prior coverage ended.
Only certain letters can be sent via email due to Cobra Federal Regulations. For more information, see What Cobra/Retiree notices are available to be sent via email to member? Go Green language will appear on several notices to notify members that they can sign up for paperless communication.
Employers should send notices by first-class mail, obtain a certificate of mailing from the post office, and keep a log of letters sent. Certified mailing should be avoided, as a returned receipt with no delivery acceptance signature proves the participant did not receive the required notice.
You begin COBRA with the employer that is providing your current health insurance. Check Your Eligibility. You may qualify for COBRA health insurance if you experience a job termination, reduction in hours, divorce, widowhood, or an adult child turning age 26 coming off their parents health insurance.
COBRA law requires that notices must be furnished to covered individuals. The preferred method of delivery is First Class Mail. Proof of receipt is not required if mailed to the last known address.
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