Discovery Benefits COBRA Benefits Termination Form free printable template

COBRA Benefits Termination Form This form is to terminate one or more benefits continued through COBRA. If participating in ACH please note Discovery Benefits needs to receive notification at least 15 days prior to the 1st of the month of your requested termination. If this form is received after that timeframe Discovery Benefits cannot guarantee that the ACH payment for that month will be cancelled. However if a payment is withdrawn you will be refunded via check. Benefits Effective Dates of...

How to fill out cobra forms wexhealth

How to fill out Discovery Benefits COBRA Benefits Termination Form

1. Obtain the Discovery Benefits COBRA Benefits Termination Form from the official website or your HR department.
2. Fill in your personal information including your name, address, and contact details.
3. Provide your COBRA coverage details such as the plan name and the dates of coverage.
4. Indicate the reason for termination of benefits clearly and concisely.
5. Confirm your signature and date at the bottom of the form to validate your request.
6. Submit the completed form according to the instructions provided, either via email, mail, or fax.

Who needs Discovery Benefits COBRA Benefits Termination Form?

1. Individuals who have previously elected COBRA benefits and wish to terminate their coverage.
2. Employees who are no longer eligible for COBRA due to changes in employment or plan conditions.
3. Dependents covered under COBRA who want to end their coverage.

People Also Ask about benefits cobra termination form

How do I cancel my COBRA Discovery benefits?

You may voluntarily terminate your coverage prior to the last day of COBRA for any reason. There are two ways to do so: Submit a completed COBRA Benefits Termination Form. Don't remit the premium payment for the month you no longer want coverage.

Does COBRA cancel automatically?

COBRA Coverage Periods You are not locked into COBRA coverage and can cancel at any time within 18 months. You will likely want to drop COBRA once you become eligible for a different health plan, such as if you get another job. If you stop paying premiums, COBRA coverage will end automatically.

Can I cancel my COBRA coverage at any time?

COBRA is generally month-to-month coverage and can be terminated at any time subject to applicable plan provisions. You can send a letter to WageWorks requesting termination of your COBRA coverage or you can simply stop paying premiums and your COBRA coverage will be terminated for non-payment.

How do you terminate COBRA coverage?

To cancel your COBRA plan you will need to notify your previous employer or the plan administrator in writing, requesting to terminate the insurance. After you stop your COBRA insurance, your former employer should send you a letter affirming termination of that health insurance.

How do I cancel my COBRA after a new job?

COBRA Coverage Periods You are not locked into COBRA coverage and can cancel at any time within 18 months. You will likely want to drop COBRA once you become eligible for a different health plan, such as if you get another job. If you stop paying premiums, COBRA coverage will end automatically.

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What is Discovery Benefits COBRA Benefits Termination Form?

The Discovery Benefits COBRA Benefits Termination Form is a document used to officially notify eligible individuals that their COBRA continuation coverage has been terminated, including the reasons for termination.

Who is required to file Discovery Benefits COBRA Benefits Termination Form?

Employers or plan administrators are required to file the Discovery Benefits COBRA Benefits Termination Form when an individual's COBRA benefits are being terminated.

How to fill out Discovery Benefits COBRA Benefits Termination Form?

To fill out the form, provide details such as the individual's personal information, the specific coverage that is being terminated, the effective date of termination, and the reason for termination.

What is the purpose of Discovery Benefits COBRA Benefits Termination Form?

The purpose of the form is to formally communicate the termination of COBRA benefits to eligible individuals, ensuring they understand the end date of their coverage and the reasons behind the termination.

What information must be reported on Discovery Benefits COBRA Benefits Termination Form?

The form must report information including the individual's name, address, the type of benefits being terminated, the termination date, and the reason for termination.