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SAMPLE Model N.J. Continuation Coverage Election Notice. (send to employee within 14 days of the termination date the carrier speci?c enrollment form via 1St
New Jersey Continuation Coverage Notice of Rights and Eligibility pages to complete the enclosed Continuation Coverage Election Form and submit it to us.
Similar to COBRA, NJ State Continuation provides rights to employees to continue . use either a carrier specific or the standard enrollment form (HINT Form) The employee must make a written election for continued coverage within 30
18 Apr 2009 If coverage terminated and New Jersey Continuation is not already in effect New Jersey Continuation Election Form to your former employer

Comparison of Federal and New Jersey Continuation Laws. FEDERAL Continuation coverage is also . COBRA coverage (election notice) within 14 days.
CONTINUATION COVERAGE PERIOD: Qualified beneficiaries may elect to INSERT COMPANY NAME'S New Jersey Continuation ELECTION FORM.
Model COBRA Continuation Coverage Election Notice. Instructions. The Department of Labor has developed a model Consolidated Omnibus Budget
To elect N.J. Continuation coverage, complete the attached (Carrier) Election Form and this document and submit them to us no later than 30 days from your loss
CONTINUATION OF THE STATE OF NEW JERSEY coverage. You elect coverage by completing the COBRA UMSA Election Form on the reverse side of this

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August 2017