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How to use or fill out IF YOU DO NOT RETURN THIS ELECTION FORM WITHIN 60 DAYS FROM THE DATE OF THIS NOTICE, YOU WILL LOSE YOUR RIGHT TO CONTINUE YOUR FSA UNDER COBRA with our platform

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Begin by entering your personal information in the designated fields, including your name, address, and contact details. Ensure accuracy to avoid any processing delays.
Review the election options carefully. Select your desired coverage level for your Flexible Spending Account (FSA) by checking the appropriate boxes provided.
Fill out any additional required fields, such as dependent information if applicable. This section is crucial for ensuring that all eligible dependents are covered under your FSA.
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What is the grace period for COBRA health insurance?

After you are established on your COBRA coverage, ongoing monthly payments are due the first day of each month. There is a grace period of 30 days from the due date for ongoing monthly premium payments. If you mail your payment, it must be postmarked within the 30-day grace period.

What is the COBRA loophole for 60 days?

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.

What happens if I miss the COBRA deadline?

Meet the Deadlines If you are eligible for Cal-COBRA and did not get a notice, contact your health plan. If you miss the deadline, you may lose the chance to sign up for Federal COBRA or Cal-COBRA. Call the Help Center if you have any questions.

What if I am late on my COBRA payment?

If you fail to make any payment before the end of the initial 45-day period, the plan can terminate your COBRA rights.

Can COBRA be backdated?

IRS Excise Tax Penalty Employers may be fined $100 per day for each qualified beneficiary affected by the non-compliance, or $200 per day per family. This penalty applies for each day the employer fails to offer or administer COBRA coverage properly.