Utah State Continuation 2026

1. Click ‘Get Form’ to open the Utah State Continuation document in our editor.
2. Begin by filling in the 'Employer Name' and 'Date' fields at the top of the form. Ensure accuracy as this information is crucial for your records.
3. Next, provide your personal details including 'Employee Name', 'Street Address', 'City', and the date you were first covered by insurance. This section helps establish your eligibility for continuation.
4. In the 'Reason insurance will stop' field, select from options such as voluntary termination or retirement. Be specific to ensure proper processing of your request.
5. Fill in the dates related to the qualifying event and when your insurance stops. This information is vital for determining your coverage timeline.
6. Finally, indicate the monthly premium amount as shown on your bill from the insurance company. Make sure this matches what you have been informed about.

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