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Employee COBRA Template

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A COBRA Election Form will allow an employee to continue its group health care coverage on a temporary basis under the former employer's plan, if the employee’s coverage would otherwise end due to termination or other change in employment status. This form also covers any dependants of the employee. This document can be customized to allow the employee’s unique information to be easily inserted into this form. This document should be used by employers seeking to establish continuation coverage under COBRA.

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