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Beneficiaries must complete a CalPERS ?Group Continuation Coverage" form (HBD-85) and an election form. For specific information and instructions for ...37 pages
beneficiaries must complete a CalPERS ?Group Continuation Coverage" form (HBD-85) and an election form. For specific information and instructions for ... I (We) elect COBRA coverage for medical, dental vision plan and/or the HCRATo elect COBRA continuation coverage, complete this Election Form and return ...3 pages
I (We) elect COBRA coverage for medical, dental vision plan and/or the HCRATo elect COBRA continuation coverage, complete this Election Form and return ...Modify this form according to the coverage plans that you offer and send it out with all COBRA notices. The employee is required to fill out and return the form ... Within the California State University system (CSU), each campus,complete a CalPERS ?Group Continuation Coverage" form (HBD-85) and an election form. The right to COBRA continuation coverage was created by a federal law,You must complete and return the COBRA Election Form within 60 days of your ... To elect COBRA coverage, complete and return this Election Form to: Santa Monica UNITEI (we) have read the COBRA Continuation Coverage Election Notice. The maximum period of COBRA Continuation Coverage is generally either 18the date you or your Dependents signed the election form and returned it to the ... COBRA and Cal-COBRA - an overview for employers with California and Federalwithout being covered under the Cal-COBRA continuation coverage as a Member. Completed COBRA Election Form must be returned within 60 daysA qualified beneficiary who waives COBRA continuation coverage can revoke the. The New York State continuation coverage law resembles the federal COBRA. It applies to employers with fewer than 20 employees and gives workers who work ...