Adams® COBRA Election Form for Employee, 1-Use Interactive Digital Legal Form
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This form is to be completed by employees seeking to participate in the COBRA program, which allows employees to remain enrolled in their employer's group health plan for a limited time when the employee has left the company. The employee is responsible for the insurance premiums if enrolled in COBRA, but receives the benefit of group coverage, which often means lower premiums.
Qualifying events include resignation, termination not due to misconduct, reduction in hours, or a child’s loss of coverage due to dependent status
Spouse or former spouse may submit for themselves and minor children in situations of divorce, legal separation, or death of a covered employee
Attorney-reviewed form valid for general use in every state
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This website provides legal forms only. We do not provide legal advice. Proper filing and service of documents and payment of related notary, court and filing fees are your responsibility. The legal documents offered from the web site are intended to be used within thirty (30) days from the time of purchase.
Valid for every state
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Legal forms created by attorneys
This website provides legal forms only. We do not provide legal advice. Proper filing and service of documents and payment of related notary, court and filing fees are the responsibility of the purchaser. The legal documents offered from this website are intended to be used within thirty (30) days from the time of purchase.
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