Cobra Election Form Letter, Model Cobra Continuation Coverage Election Notice Alexander Street A Proquest Company

This means that bcbsnc will receive cobra election forms certain required cobra notices and continuation payments.

Election canada office richmond bc. To use this model election notice properly the plan administrator must fill in the blanks with the appropriate plan information. Fill out securely sign print or email your cobra election form 2013 2020 instantly with signnow. To elect cobra continuation coverage follow the instructions to complete the election form mkt 365 and submit it to the plan administrator at the address below.

The most secure digital platform to get legally binding electronically signed documents in just a few seconds. Single single single family family family you do not have to send any payment with the election form. This election form should be included in your cobra election packet mkt 171.

This notice must be sent to the plan participants and beneficiaries by first class mail or hand delivered not later than 14 days after the plan administrator receives notice that a qualifying event occurred. If you choose to elect cobra continuation coverage you should use the election form included in this notice. Important additional information about payment for cobra continuation coverage is included in the pages following the election form.

The contact information for bcbsnc is. Cobra continuation unit bcbsnc p o box 2291 durham north carolina 27702 1 888 694 7860. The completed election form must be postmarked no later than 60 days from the date of this letter or the loss of your coverage whichever is later.

Under federal law you must have 60 days after the date of this notice to decide whether you want to elect cobra continuation coverage under the plan. In this notice the words you or your refer to each of the individuals included at the. Cobra continuation coverage election form.

Enter name and address. If you choose to elect extended coveragecobra you should use the election form provided later in this notice and submit it to the designated individual by the end of the 60 day election period specified on the election form. If you have any questions concerning the information in this notice or your rights to coverage you should contact the trust administrator epk associates 15375 se 30th place 380 bellevue wa 98007 1 800 545 7011 or admin.

Cobra continuation coverage will cost. Blank cobra election forms. Send completed election form to.

The department of labor has developed a model consolidated omnibus budget reconciliation act of 1985 cobra continuation coverage election notice that the plan may use to provide the election notice. Coverage options described in the election form provided with this notice. To elect cobra continuation coverage follow the instructions and complete the cobra continuation coverage election form and submit it to hfs cobra.