RESOURCE CENTER

Installation Forms
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06.18.2012
Broker Implementation Checklist
This checklist is to assist a broker in collecting all the necessary information and paperwork, needed to transition a client to COBRA Care, for COBRA or State Continuation administration. Please be advised some items may change over time.
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06.18.2012
Pricing Agreement
This is the standard pricing agreement for standard COBRA administrative services through COBRA Care. There is a per notice pricing option as well which is not shown here. THIS IS EXCLUSIVE PRICING FOR BROWN & BROWN BROKERS ONLY.
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06.18.2012
Broker Authorization form
Agreement to be completed employer and broker, if the employer wishes to have broker submit information on their behalf to COBRA Care.
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06.18.2012
Pending COBRA Participants form
To be completed by employer if they have any Qualified Beneficiary who has experienced a Qualified Event and has already been sent a COBRA specific rights notice, but has not yet elected; while group is transitioning administration to COBRA Care.
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06.18.2012
Current COBRA employee form
To be completed by employer if they currently have qualified beneficiaries on COBRA, while the group is transitioning their COBRA administration to COBRA Care.
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06.18.2012
Client Service Agreement
To be completed by the client, HOWEVER, this file is strictly for an example for your review. The actual file will be tailored to the client and vary by the type of service and pricing option they elect. DO NOT USE this file.
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06.11.2012
Employer Questionnaire - Carrier Information
COBRACare Questionnaire for Employers to complete in order to obtain the correct insurance carrier information (carrier name, policy number, etc.) to establish their COBRA administration account. Complete one form for EACH plan offered.
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06.11.2012
Employer Questionnaire - Profile
COBRACare Questionnaire for Employers to complete in order to obtain the correct profile information (name, address, contact information, etc.) to establish their COBRA administration account.
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