How to Sign Up for COBRA Late
Instructions
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Go to the COBRA insurance website.
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Look to the right side of the COBRA insurance homepage. The available form is the registration form to start the preliminary process for acquiring COBRA insurance.
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3
Type your first, last name in the appropriate field. Then, provide your home address and zip code.
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4
Click the appropriate radio button for your preferred method of contact. Enter the email address or phone number for your preferred method of contact.
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Enter your approximate weight and height. Then, click the appropriate radio button for Tobacco Usage.
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Use the designated drop-down bars to enter your gender, birthdate and preferred type of coverage.
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Provide the name of your employer (f applicable).
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8
Type an approximate date to indicate when your last insurance coverage ended.
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Answer the question regarding pre-existing coverage needs by clicking the appropriate "Yes" or "No" radio button.
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Click the "Submit" button at the bottom of the COBRA registration form. A COBRA representative will contact you with further information, coverage rates, and plan options so you can move forward with the process.
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