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Request for Continued Medical Coverage



The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. Qualified individuals may be required to pay the entire premium for coverage up to 102 percent of the cost to the plan. Through this form, 'Request for Continued Medical Coverage' you can request medical coverage after job termination.

Included In Employee Rights Kit

Price: Included In Employee Rights Kit

Available formats

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