Form A10661 Extended Coverage / Cobra Change Request - Commonwealth of Virginia Health Benefits Program - Virginia

What Is Form A10661?

This is a legal form that was released by the Virginia Department of Human Resource Management - a government authority operating within Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form A10661?A: Form A10661 is an Extended Coverage/Cobra Change Request form.

Q: Who is the form for?A: The form is for participants in the Commonwealth of Virginia Health Benefits Program - Virginia.

Q: What is the purpose of the form?A: The form is used to request changes or updates to extended coverage or COBRA benefits.

Q: What kind of changes can I request using this form?A: You can request changes to your extended coverage or COBRA benefits, such as adding or removing dependents.

Q: Is there a deadline to submit the form?A: It is important to submit the form within the specified timeframe provided by the Commonwealth of Virginia Health Benefits Program.

Q: Can I make changes to my benefits outside of the annual open enrollment period?A: Yes, you can use this form to make changes to your extended coverage or COBRA benefits outside of the open enrollment period.

Q: Who should I contact if I need help filling out the form?A: For assistance in filling out the form, you should contact the Commonwealth of Virginia Health Benefits Program - Virginia.

Q: Are there any fees associated with submitting the form?A: Please refer to the guidelines and instructions provided by the Commonwealth of Virginia Health Benefits Program for any applicable fees.