Cobra Forms and Templates

Cobra Forms are used for various purposes related to the Consolidated Omnibus Budget Reconciliation Act (COBRA). These forms are typically used to facilitate the continuation of health insurance coverage for individuals and their dependents when they experience certain qualifying events such as job loss, reduction in work hours, divorce, or other life events. The forms help individuals to elect and enroll in COBRA coverage, understand their rights and options, and provide the necessary information to the employer or insurance provider.




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This form is used for retirees and individuals eligible for COBRA coverage to choose a pre-payment option for their healthcare costs.

This Form is used for electing continuation of COBRA health insurance coverage.

This document provides information about special enrollment rights and the waiver form for the Choice Cobra program.

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