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LEGAL DISCLAIMER:
Information contained in this publication is not legal advice, and
should not be construed as legal advice. If you need legal advice upon which you can rely,
you should seek a legal opinion from your attorney.
The DOL listed the
following documents
that are necessary to complete
an online
application:
COBRA election notice;
Information on your plan sponsor, employer, insurance company and/or plan
administrator;
A “Request for Treatment as an Assistance Eligible Individual" or other form
used to request the premium reduction;
Insurance information card;
Payroll stubs showing deductions for health benefits;
Any documents detailing the date and circumstances of the termination of
the employee’s employment; or
Any documentation you were provided regarding the denial of the premium
reduction.
According to the DOL, the following file formats are acceptable for submitting the
above listed documents:
Plain text (txt or rtf)
MS Word
®
(doc)
MS Excel
®
(xls)
Joint Photographic Experts Group (jpeg)
CompuServe Graphics Interchange (gif)
Tagged Image File (tiff)
Bitmap (bmp)
Adobe Portable Document Format (pdf)
Note: According to the DOL, users
filing the Appeal Form online
cannot save
information. Once a user has begun the
process, if left unattended, the user
will
receive a 15 minute warning and the user’s computer session will time-out after 30
minutes. If the user’s session has timed-out, the user will need to begin the Appeal
Form process again and re-enter any information previously entered.
FURTHER RESOURCES
The main IRS COBRA premium subsidy webpage is located at:
The main DOL COBRA premium subsidy webpage is located at:
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