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Cobra benefits termination form

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I understand my submission of this form is a request to terminate the specified benefit s indicated above. When terminating all benefits with an overpayment balance remaining you will only receive a refund check if the amount is greater than 25. 00. Lesser amounts are used by the employer who sponsors the group health plan to pay for plan administration expenses. Standard processing time for refunds is 15 business days from the date this completed form is received. Step 1 Primary Qualified Bene ...

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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 a COBRA General Notice?

The Initial General COBRA Notice provides a summary of the covered individual's rights, options, and notification responsibilities under the COBRA law. This notice must contain the following information: Description of COBRA terms. Name of the employee, spouse/domestic partner, and *dependent children.

How Long Can You Get COBRA after you quit your job?

COBRA allows you to continue coverage \u2014 typically for up to 18 months \u2014 after you leave your employer. You can buy an Affordable Care Act (ACA) plan through a public exchange on the health insurance marketplace. Or you can switch to your spouse or partner's plan, if possible.

Does COBRA automatically cancel?

Can I cancel my COBRA coverage? COBRA coverage can be cancelled. However, if you choose to cancel coverage, it cannot be reinstated. Coverage will be automatically cancelled if your payment is not postmarked on or before the deadline date of the month your premium is due.

How do I terminate COBRA?

To cancel your COBRA plan you will need to notify your previous employer or the plan administrator in writing, requesting to terminate the insurance. After you stop your COBRA insurance, your former employer should send you a letter affirming termination of that health insurance.