Can I cancel my COBRA coverage at any time?

COBRA is generally month-to-month coverage and can be terminated at any time subject to applicable plan provisions. You can send a letter to WageWorks requesting termination of your COBRA coverage or you can simply stop paying premiums and your COBRA coverage will be terminated for non-payment.

How do I write a COBRA termination letter?

The notice must explain the reason coverage has terminated, provide the date of termination and describe any rights the qualified beneficiary may have to elect alternative group or individual coverage, such as a conversion right (29 C.F.R. 2590.606-4(d)).

How do I cancel my COBRA Discovery benefits?

To cancel your COBRA plan you will need to notify your previous employer or the plan administrator in writing, requesting to terminate the insurance. After you stop your COBRA insurance, your former employer should send you a letter affirming termination of that health insurance.

How do you call Cobra?

Administration electronically or call toll free 1-866-444-3272.

How do I contact Cobra Insurance California?

You can reach Covered California at (800) 300-1506 or online at .coveredca.com. You can apply for individual coverage directly through some health plans off the exchange.

How does COBRA work after being terminated?

You may be able to keep your job-based health plan through COBRA continuation coverage. COBRA coverage lets you pay to stay on your job-based health insurance for a limited time after your job ends (usually 18 months). You usually pay the full premium yourself, plus a small administrative fee.

US Legal Forms
Form Library
Industry Forms
Industry Insurance & Medical Forms
Discovery Benefits Cobra Benefits Termination Form

Get Discovery Benefits Cobra Benefits Termination Form

COBRA Benefits Termination Form This form is to terminate one or more benefits continued through COBRA. If participating in ACH please note Discovery Benefits needs to receive notification at least 15 days prior to the 1st of the month of your requested termination. If this form is received after that timeframe Discovery Benefits cannot guarantee that the ACH payment for that month will be cancelled. However if a payment is withdrawn you will be refunded via check. Benefits Effective Dates of Termination mm/dd/yyyy Person s Affected PQB and/or Dependents Medical Dental Vision Other If the reason for requesting termination is due to death of the former employee divorce or legal separation from the former employee or a dependent child s ceasing to be a dependent please use the COBRA Second Qualifying Event Form. I understand my submission of this form is a request to terminate the specified benefit s indicated above. When terminating all benefits with an overpayment balance remaining you will only receive a refund check if the amount is greater than 25. 00. Lesser amounts are used by the employer who sponsors the group health plan to pay for plan administration expenses. Standard processing time for refunds is 15 business days from the date this completed form is received. Step 1 Primary Qualified Beneficiary Information Required Fields - Primary Qualified Beneficiary Name First MI Last Social Security Number Previous Employer Do not abbreviate Day Telephone Email Address Step 2 Benefit Termination Information Please specify the benefit s you are requesting to discontinue through COBRA. When terminating all benefits with an overpayment balance remaining you will only receive a refund check if the amount is greater than 25. 00. Lesser amounts are used by the employer who sponsors the group health plan to pay for plan administration expenses. Standard processing time for refunds is 15 business days from the date this completed form is received* Step 1 Primary Qualified Beneficiary Information Required Fields - Primary Qualified Beneficiary Name First MI Last Social Security Number Previous Employer Do not abbreviate Day Telephone Email Address Step 2 Benefit Termination Information Please specify the benefit s you are requesting to discontinue through COBRA. Please also indicate the effective date you are requesting coverage to terminate as well as the person s affected by the change. Further I understand Discovery Benefits will contact me if my request to terminate coverage is denied for any reason* Date Spouse Signature Only required if coverage is being terminated for the spouse but not the PQB Date C002. When terminating all benefits with an overpayment balance remaining you will only receive a refund check if the amount is greater than 25. 00. Lesser amounts are used by the employer who sponsors the group health plan to pay for plan administration expenses. 00. Lesser amounts are used by the employer who sponsors the group health plan to pay for plan administration expenses. Standard processing time for refunds is 15 business days from the date this completed form is received* Step 1 Primary Qualified Beneficiary Information Required Fields - Primary Qualified Beneficiary Name First MI Last Social Security Number Previous Employer Do not abbreviate Day Telephone Email Address Step 2 Benefit Termination Information Please specify the benefit s you are requesting to discontinue through COBRA. .

How It Works

Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save

cobra forms for terminated employees rating

★ ★ ★ ★

★ ★ ★

★ ★

★

4Satisfied

41 votes

How to fill out and sign Forms discoverybenefits com online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Feel all the benefits of completing and submitting legal forms on the internet. With our platform completing Discovery Benefits COBRA Benefits Termination Form only takes a few minutes. We make that possible by giving you access to our full-fledged editor capable of altering/correcting a document?s original text, inserting unique fields, and e-signing.

Fill out Discovery Benefits COBRA Benefits Termination Form in a few moments by using the instructions below:

Choose the document template you need from the collection of legal forms.
Select the Get form key to open it and move to editing.
Complete all of the necessary boxes (they will be yellowish).
The Signature Wizard will allow you to insert your electronic autograph as soon as you?ve finished imputing info.
Put the relevant date.
Check the entire form to ensure you have completed everything and no changes are needed.
Click Done and save the resulting form to your gadget.

Send your Discovery Benefits COBRA Benefits Termination Form in a digital form as soon as you finish filling it out. Your data is well-protected, as we keep to the latest security standards. Become one of numerous satisfied customers that are already filling in legal forms right from their homes.

How to edit Discovery benefits termination: customize forms online

Facilitate your paperwork preparation process and adjust it to your requirements within clicks. Complete and sign Discovery benefits termination using a powerful yet easy-to-use online editor.

Managing paperwork is always burdensome, especially when you deal with it from time to time. It demands you strictly adhere to all the formalities and accurately fill out all areas with full and accurate data. Nevertheless, it often occurs that you need to modify the form or insert extra areas to fill out. If you need to optimize Discovery benefits termination prior to submitting it, the best way to do it is by using our powerful yet simple-to-use online editing tools.

This comprehensive PDF editing tool allows you to quickly and easily complete legal paperwork from any internet-connected device, make fundamental edits to the form, and insert more fillable areas. The service allows you to opt for a particular area for each data type, like Name, Signature, Currency and SSN etc. You can make them required or conditional and decide who should complete each field by assigning them to a defined recipient.

Make the steps below to modify your Discovery benefits termination online:

Open required file from the catalog.
Fill out the blanks with Text and place Check and Cross tools to the tickboxes.
Utilize the right-side panel to adjust the template with new fillable areas.
Pick the areas based on the type of information you wish to be collected.
Make these fields required, optional, and conditional and customize their order.
Assign each field to a particular party using the Add Signer tool.
Check if you’ve made all the required changes and click Done.

Our editor is a versatile multi-featured online solution that can help you easily and quickly adapt Discovery benefits termination and other forms based on your needs. Reduce document preparation and submission time and make your documentation look professional without hassle.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to discovery termination

discovery benefits omaha ne
discovery benefits terminate account
discovery cancellation form
discovery cobra
discovery cobra benefits
discovery cobra phone number
discovery benefits llc omaha ne
discoverybenefits cobra
discoverybenefits cobra login
discoverybenefits cobra termination form
formsdiscoverybenefitscobra
how to cancel cobra discovery benefits
https cobra discoverybenefits com
cobra benefits termination form discovery benefits
discovery benefits cancellation form

If you believe that this page should be taken down, please follow our DMCA take down processhere.

VeriSign secured

#1 Internet-trusted security seal. Ensures that a website is free of malware attacks.
Accredited Business

Guarantees that a business meets BBB accreditation standards in the US and Canada.
TopTen Reviews

Highest customer reviews on one of the most highly-trusted product review platforms.