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Residents and Clinical Fellows: Cobra
Residents & Clinical Fellows that separate from the University may be may be eligible to continue their medical, dental and vision coverage under COBRA continuation.
- COBRA Rates, 2010-2011
- COBRA Rates, 2011-2012
- COBRA Acknowledgement Form
- COBRA Contacts (where to send premiums)
- ACTIONS REQUIRED: When Employees Separate (COBRA Enrollment Process)
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Health Net Insurance Enrollment Form - COBRA
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Vision Service Plan Enrollment Form - COBRA
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Dental and Blue Cross Enrollment Form (UniCare) - COBRA
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Please use this form for enrolling in COBRA for Delta Dental and/or Blue Cross only. Blue Cross Group Number: 175138M; Delta Dental Group Number: 0510-0004. Enter N/A in Eligibility Code box. Once completed please mail to the address on the form.