Instructions and Helpful Tips on Making Your COBRA Election

You are required to complete and return the COBRA Continuation Coverage Election Form and any carrier applications that correspond with the plans you wish to continue participation in within 60-days after receipt. Incomplete COBRA elections cannot be processed and will result in a delay in your COBRA election process.

Remember to place a check mark next to ACCEPT for the benefits shown on the COBRA Continuation Coverage Election Form in which you wish to continue to participate or place a check mark next to WAIVE for the benefits in which you do not wish to continue to participate. If carrier applications were enclosed, you must complete and return those applications which correspond to the benefits you are electing to continue. Please be sure to complete all personal information requested on any enclosed forms. Failure to do so will result in a delay in processing your paperwork. EBS will complete sections regarding employer name, group number and signature. Your completed forms and any questions you may have should be directed to EBS.

Upon receipt of your completed COBRA election, you will be mailed payment coupons in which to use when making premium payments. You will not receive a monthly statement. Your coverage will not be reactivated under COBRA until your initial premium payment is received. Therefore, you may send payment with your completed COBRA election. Your initial premium payment must cover the period of time from which coverage under the active plan was lost up to the date your initial premium payment is postmarked. (Example: If your COBRA begins 1/1/2010, and your first payment is postmarked after 1/31/2010, your first payment must include payment for the coverage periods of 1/1/2010 – 1/31/2010 and 2/1/2010 – 2/28/2010.) If your former employer has agreed to pay your COBRA premiums for a specified time period, an initial premium payment may not be required.

You are responsible for making sure that the amount of your initial premium payment is correct. You may contact EBS to confirm the correct amount of your initial premium payment.

Important: After satisfying your initial premium payment, subsequent premium payments are due on the 1st of each month. You have a 30-day grace period from the due date in which to have your premium payment postmarked. If timely payment is not made, your COBRA coverage will be terminated retroactively to the date in which timely payment was not made. Once coverage has been terminated, it cannot be reactivated.

NOTE: Once EBS receives your completed COBRA election and initial premium payment, please allow 7 to 10 days for your coverage to be showing active within the carrier systems.

You can e-mail us with questions here. You may also call EBS at 888.327.2770.

Information Release Document



PO Box 11657
Pleasanton, CA 94588
Employees / Members 888.327.2770
Employers/ Brokers 800.229.7683