Instructions

1

Determine if you are eligible for COBRA coverage. If your termination was not due to gross misconduct, you qualify for COBRA coverage, even if you were fired or left voluntarily. Contact your employer to verify your termination was not for gross misconduct.
2

Call your former employer to obtain the COBRA application documents if they do not send them automatically within 14 days of your termination date.
3

Complete the COBRA election form and mail or fax it to the insurance company. Most COBRA applications are brief and ask you to give your name, date of termination, dependent information and the types of coverage you want to keep such as health, vision and dental benefits.