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Davevic Benefit Consultants, Inc.

Forms

We’ve made our most commonly used forms available online for download.

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COBRA
I have over 20 employees, should I send COBRA?
In almost all circumstances, YES!
Unless there is documented evidence of Gross Misconduct (theft, assault, repeated substance abuse on the job, etc.) employers are required to provide continuation to employees who lose coverage

I have under 20 employees, should I send mini-COBRA?
In most circumstances, yes. Please refer the PA Mini-COBRA guidelines below for more information. You do not need to send mini-COBRA whenever:
• The person losing coverage is eligible for Medicare
• The person losing coverage has not been continuously covered for 3 months
• The person losing coverage was not enrolled in the medical plan

Commonly Used Forms



Major Carriers
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