Please refer to the COBRA Election Notice for specific instructions.
ARRA Ineligibility
form - If you are receiving COBRA premium subsidy and become
ineligible for the subsidy, you are required to notify the EUTF by completing
this form.
Notice of a
COBRA-Related Event form - You must use this form to report any event
that qualifies your dependents for COBRA continuation coverage.
Change of Address form
- It is imperative that you notify the EUTF of any address changes.
Request
for Treatment as an Assistance Eligible Individual form - If you were
terminated from employment and believe that you re eligible for the COBRA
premium subsidy, you must complete and submit this form to the EUTF.Before you can be enrolled, your employer
must validate your eligibility.
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