COBRA continuation coverage

COBRA continuation coverage

The right to COBRA continuation coverage was created by a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage can become available to you when you would otherwise lose your group health coverage. It can also become available to other members of your family who are covered under the Plan when they would otherwise lose their group health coverage.

Are you eligible for COBRA continuation coverage?
For additional information about your rights and obligations under the plan and under federal law, you should review your plan's member handbook and the Department of Labor's FAQ (external link).

Member coverage information

The plan documents describing your benefits can be found on your plan’s member page.
These are the same documents referenced while you were a covered employee, spouse or dependent.

For more information, read through our frequently asked questions.

Member forms

The following forms should be used to provide information you are required to report to Samaritan Health Plan Operations (SHPO):

Address notification: Report a change of address for yourself or any covered dependent that receives mail at an address different from yours. If you are a current employee, please remember to also update your information in PeopleSoft.

Qualifying event or extension notification: You are required to report certain events that occur while you or your dependents are on COBRA continuation coverage. Complete this form and follow the instructions to provide the required information and documentation to SHPO.

Continuation coverage election: After you have received an Election Notice, use this form to elect COBRA continuation coverage for yourself or another qualified beneficiary.

COBRA drop coverage or early termination: After you have elected COBRA continuation coverage, use this form to list members that need some or all coverage dropped.

COBRA recurring credit card payments: After you have elected COBRA continuation coverage, use this form to setup recurring credit card payments for your COBRA monthly premiums.

Last modified: Feb. 10, 2015