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Administration Instructions for Groups

Employee Application/Deletion or Change Form

Please use the Individual application for adding a new employee, deleting an existing
employee or changing dependent status on an existing employee's coverage. 
You can also use our web forms to report these changes




Cal-COBRA groups will give us the members address upon termination of coverage and we will generate the Cal-COBRA election form and invoice the member directly for the coverage. 

Federal COBRA groups will need to issue a COBRA form upon the qualifying event.  
Please follow this link to view and download model notices provided by the Department of Labor.

COBRA Continuation Coverage | U.S. Department of Labor (

When the member elects COBRA, pease use the Add Employee and/or Dependents to the plan form to re-add the member on to your plan.  Members who extend coverage under Federal COBRA will be invoiced with the group and the individual premium collection is done by the group.

Please follow this link for a definition of Federal COBRA vs. Cal-COBRA and to notify us which COBRA regulations apply to your group.


Click here to view and print Certificates and Plan descriptions