COBRA - Request for Continuation of Coverage Form

As a DEBCP (Designated Employee Benefits Contact Person) you must provide the Request for Continuation of Coverage - COBRA form to employees as appropriate.

Since this is a carbon copy (duplicate) form, it is not available on the internet, and must be completed either by typewriter or pen -with signature(s) required.

You should request forms directly from Employee Benefits by phone at (612) 624-9090 or via email at:

Further information and other related forms are available on the Employee Benefit website at:

About this Entry

This page contains a single entry by ludow006 published on May 27, 2009 11:39 AM.

Important Information for CLA Administrator and CLA Financial Service Teams was the previous entry in this blog.

DMS Updates is the next entry in this blog.

Find recent content on the main index or look in the archives to find all content.

Weekly Archives


Powered by Movable Type 4.31-en