Adams® COBRA Election Form for Employee, 1-Use Interactive Digital Legal Form

Item: 1679770Model: DLF498-SL
Only Available Online
  • Qualifying events include resignation, termination not due to misconduct, reduction in hours, or a child’s loss of coverage due to dependent status
  • Spouse or former spouse may submit for themselves and minor children in situations of divorce, legal separation, or death of a covered employee
  • Attorney-reviewed form valid for general use in every state
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