COBRA Open Enrollment Form for Health Elections
This document provides important details and instructions for The Ohio State University's COBRA Open Enrollment Form. It allows employees to change health elections and drop coverage effectively from January 1, 2024. Ensure timely completion to avoid coverage lapses.
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How do I fill this out?
Filling out the COBRA Open Enrollment Form is straightforward. Start by gathering your personal information and the details of any dependents. Follow the instructions carefully to ensure all required fields are completed.
How to fill out the COBRA Open Enrollment Form for Health Elections?
1
Gather personal and dependent information.
2
Select the desired health coverage options.
3
Indicate dependents enrolling under COBRA.
4
Read and understand the certification section.
5
Sign and date the form before submission.
Who needs the COBRA Open Enrollment Form for Health Elections?
1
Current employees wishing to change their health coverage.
2
Employees dropping health coverage.
3
Dependents of employees enrolling in COBRA.
4
Newly eligible employees needing to understand options.
5
HR personnel assisting with health plan enrollments.
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What are the instructions for submitting this form?
To submit the COBRA Open Enrollment Form, you can send the completed form to Trustmark Health Benefits via mail or fax. The physical address is Trustmark Health Benefits, COBRA, PO Box 416025, Boston MA 02241-6025, and the fax number is 1-704-527-2162. Ensure to include your Trustmark ID and other required information to avoid processing delays.
What are the important dates for this form in 2024 and 2025?
Important dates include the due date for the form submission on November 17, 2023, and the effective coverage date starting January 1, 2024. Ensure all details are finalized ahead of these deadlines to maintain uninterrupted health coverage.
What is the purpose of this form?
The purpose of the COBRA Open Enrollment Form is to facilitate health coverage elections for qualified employees and their dependents. It allows changes to health plans and ensures compliance with COBRA regulations. Properly completing this form plays a vital role in maintaining access to necessary health benefits.
Tell me about this form and its components and fields line-by-line.
- 1. Personal Information: Full name, address, phone number of the employee and COBRA enrollees.
- 2. Reason for Completing Form: Identifies the purpose behind changes in health coverage.
- 3. Health Plan Coverage Selection: Options for medical, dental, and vision coverage.
- 4. Enrollee Information: Details about dependents enrolling in the chosen coverage.
- 5. Certification: Acknowledgment of understanding the terms of coverage.
What happens if I fail to submit this form?
Failure to submit the COBRA Open Enrollment Form can result in a loss of health coverage options for you and your dependents. Important deadlines are in place to ensure that you stay enrolled in the necessary health plans. Missing these deadlines may require you to wait until the next enrollment period to make changes.
- Loss of Coverage: Missing the submission deadline may lead to loss of health coverage.
- Ineligible for Future Enrollment: Failing to submit may prevent you from enrolling during future enrollment periods.
- Financial Impact: Lack of coverage can lead to significant out-of-pocket healthcare expenses.
How do I know when to use this form?
- 1. Open Enrollment Period: Use the form during the designated open enrollment period to make changes.
- 2. Change of Status: Submit the form if there has been a qualifying change in your life status.
- 3. Add Dependents: Utilize the form to add eligible dependents to your health coverage.
Frequently Asked Question
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Yes, PrintFriendly allows you to edit the COBRA Open Enrollment Form easily.
What information do I need to fill out this form?
Gather your personal information and that of any dependents before starting your form.
How do I submit the completed form?
You can submit the completed form via the specified mailing address or fax number.
Can I download the form after editing?
Absolutely! Once you finish editing, you can download the final version of your form.
What should I do if I have questions about the form?
Contact Trustmark using the provided phone number or email address for assistance.
Is there a deadline for submitting this form?
Yes, ensure to submit the form by the designated deadlines to secure your health coverage.
What if I need to make changes after submitting?
If you need to make changes, you must notify Trustmark as per the guidelines provided.
Can dependents fill out the form on their behalf?
Yes, dependents can fill out the form if they are enrolling in COBRA.
Where can I find additional resources for filling this form?
Visit hr.osu.edu for helpful resources and information regarding the COBRA health plans.
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