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: benefits@umn.edu

Further information and other related forms are available on the Employee Benefit website at: http://www1.umn.edu/ohr/debcp/index.html

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

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