Chicago Illinois Sample COBRA Enrollment and / or Waiver Letter

• Category: Employment - Cobra
• State: Multi-State
• City: Chicago
• Control #: US-499EM
• Format: Word

Description

This Employment & Human Resources form covers the needs of employers of all sizes. Chicago, Illinois Sample COBRA Enrollment and / or Waiver Letter [Your Name] [Your Address] [City, State, Zip Code] [Email Address] [Phone Number] [Date] [Employer Name] [Human Resources Department] [Address] [City, State, Zip Code] Subject: COBRA Enrollment and / or Waiver Letter Dear [Employer's Name], I am writing to formally request information regarding my eligibility for COBRA continuation coverage pursuant to the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. As an employee who has recently experienced a qualifying event, I seek your guidance on the enrollment and/or waiver options available to me. Following the termination of my employment with [Company Name/Cobra Administrator] on [Termination Date], I understand that I am entitled to elect COBRA continuation coverage for the health insurance plan provided by the employer. I would appreciate receiving the necessary details and documents pertaining to COBRA, including the applicable plan options, premium rates, and enrollment instructions. I kindly request that you provide me with the COBRA enrollment package without delay, preferably within the timeframe specified under federal law. This will enable me to make an informed decision about continuing my healthcare coverage. Moreover, if there are any necessary enrollment forms or waivers that require completion, please forward them to me at your earliest convenience. In the event that I am eligible for COBRA but do not wish to enroll, I would appreciate receiving a waiver form to confirm my decision explicitly. This will help me to avoid any potential misunderstandings and ensure compliance with COBRA regulations. I understand that I am responsible for paying the required premiums, which may include an additional administrative fee for continued coverage. Therefore, I kindly request that you provide me with the necessary information on the premium amounts, payment methods, and deadlines to ensure a seamless continuation of coverage. I kindly ask for your prompt attention to this matter so that any potential gaps in my healthcare coverage can be avoided. Please keep in mind that under COBRA regulations, the deadline for enrollment or waiver submission typically falls within 60 days from the qualifying event date. If you require any further information or have any questions regarding my eligibility or the COBRA process, please do not hesitate to contact me at the provided phone number or email address. Thank you for your cooperation and support in this matter. I look forward to receiving the requested COBRA information at your earliest convenience. Sincerely, [Your Name]

Chicago, Illinois Sample COBRA Enrollment and / or Waiver Letter [Your Name] [Your Address] [City, State, Zip Code] [Email Address] [Phone Number] [Date] [Employer Name] [Human Resources Department] [Address] [City, State, Zip Code] Subject: COBRA Enrollment and / or Waiver Letter Dear [Employer's Name], I am writing to formally request information regarding my eligibility for COBRA continuation coverage pursuant to the provisions of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. As an employee who has recently experienced a qualifying event, I seek your guidance on the enrollment and/or waiver options available to me. Following the termination of my employment with [Company Name/Cobra Administrator] on [Termination Date], I understand that I am entitled to elect COBRA continuation coverage for the health insurance plan provided by the employer. I would appreciate receiving the necessary details and documents pertaining to COBRA, including the applicable plan options, premium rates, and enrollment instructions. I kindly request that you provide me with the COBRA enrollment package without delay, preferably within the timeframe specified under federal law. This will enable me to make an informed decision about continuing my healthcare coverage. Moreover, if there are any necessary enrollment forms or waivers that require completion, please forward them to me at your earliest convenience. In the event that I am eligible for COBRA but do not wish to enroll, I would appreciate receiving a waiver form to confirm my decision explicitly. This will help me to avoid any potential misunderstandings and ensure compliance with COBRA regulations. I understand that I am responsible for paying the required premiums, which may include an additional administrative fee for continued coverage. Therefore, I kindly request that you provide me with the necessary information on the premium amounts, payment methods, and deadlines to ensure a seamless continuation of coverage. I kindly ask for your prompt attention to this matter so that any potential gaps in my healthcare coverage can be avoided. Please keep in mind that under COBRA regulations, the deadline for enrollment or waiver submission typically falls within 60 days from the qualifying event date. If you require any further information or have any questions regarding my eligibility or the COBRA process, please do not hesitate to contact me at the provided phone number or email address. Thank you for your cooperation and support in this matter. I look forward to receiving the requested COBRA information at your earliest convenience. Sincerely, [Your Name]