Qualifying Event Form
Cobra Companion Site (for eligible CAHS clients)
Employer COBRA Application and Renewal
Existing COBRA Member Form
Penalties for Non Compliance
FMLA Leave Request Form
Request For Proposal
Please supply information about your company and it's employee healthcare coverages.
For initial applications, please email firstname.lastname@example.org.
Please note that CAHS processes ONLY COBRA reinstatements and COBRA cancellations.
The Employer is responsible for processing new enrollments and the initial termination with the insurance carriers.
If your plans are age rated:
Increases due to birthdays, resulting in rate change, occur: At renewal At the birthday month
Rate Grid(s) - Please upload up to three files (Types accepted: pdf, xls, xlsx, doc, docx, txt, csv, jpg, png):
Please provide any additional comments you may feel are relevant to your application.
BASIC New England
3649 Post Road - Warwick, RI 02886
401.921-3514 (p) 401.921.3518 (f)
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