COBRA Coverage Continuation

Customizable form for COBRA Coverage Continuation. Complete the form directly from your tablet or smartphone, and send it via email (or you can print it too!) when you’re done.

The Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions amend the Employee Retirement Income Security Act, the Internal Revenue Code and the Public Health Service Act to require group health plans to provide a temporary continuation of group health coverage that otherwise might be terminated.

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