Cobra letter 2026

1. Click ‘Get Form’ to open the cobra letter in the editor.
2. Begin by entering the date at the top of the form, followed by the enrollment deadline. This ensures that all parties are aware of important timelines.
3. Fill in your name and the names of any enrolled dependents. This section is crucial for identifying who will be covered under the COBRA benefits.
4. Indicate your address, city, state, and zip code to provide accurate contact information.
5. As the Principal Qualified Beneficiary, select one of the options regarding coverage: for yourself only, for dependents only, for your family, or decline coverage. Make sure to check the appropriate box.
6. Review and understand the cost per month for each coverage option you select. Ensure you are prepared for timely payments as outlined in the document.
7. Sign and date where indicated. If applicable, have your spouse or other dependent over age 18 sign as well.

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