1. COBRA administration form
New groups fill out this form when they contract with BASIC.
Online form

2. Insurance company information form
New groups fill out this form when they contract with BASIC.
Existing groups fill out this form when there are rate changes.
Online form

3. Current COBRA participant information form
New groups with existing COBRA participants fill out this form.
Online form

4. Initial notification form
Use this form for all new additions to health plan.
Online form

5. COBRA qualifying event form
Use this form for all qualifying events
Online form

6. Unavailability of COBRA coverage form
Please contact our COBRA department before using this form.
Online form

Click here to access PDFs of the above COBRA forms.