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COBRA Information

 

If you have recently become covered under the Peralta Colleges Health Plan, the download below contains important information about your right to COBRA continuation coverage, which is a temporary extension of coverage under the Plan. The right to COBRA continuation coverage was created by a federal law, called the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). COBRA continuation coverage may become available to you and to other members of your family who are covered under the Plan when you would otherwise lose your group health coverage.

 

Downloads
 COBRA Ennrollment Form  
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DOWNLOAD

Attached is the Peralta COBRA Universal Enrollment Form. 

  File size: 50 K

 Department of Labor's Notice 2009 - 27  
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DOWNLOAD

This notification contains a comprehensive Q & A list under the American Recovery and Reinvestment Act (ARRA) as issued by the Department of Labor.

 For additional information on the ARRA legislation, you may visit the Department of Labor's website at www.dol.gov.

  File size: 82 K

 COBRA Initial Notification  
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This is the COBRA Initial Notification for Peralta employees.

  File size: 71 K

 Subsidy Waiver  
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Use this form to notify Peralta if you are no longer eligible for the government subsidy program as specified under the American Recovery and Reinvestment Act (ARRA).  Failure to notify Peralta of your ineligibily for the subsidy may result in a tax penalty. 

  File size: 53 K

 Subsidy Application  
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Complete this application for government subsidy of COBRA premiums.  Upon completion, return to PCCD Benefits, 333 East 8th Street, Oakland, CA 94606.

  File size: 71 K


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