Forms
The BenefitHelp Solutions COBRA Event Notification Spreadsheet
The COBRA Event Notification Spreadsheet provides contracted employer
groups with a tracking tool for future reference and timely delivery of
COBRA notices to your employees.
BenefitHelp Solutions will confirm receipt of The COBRA Event Notification Spreadsheet and
will use the spreadsheet to generate the COBRA Notice and Election Forms.
To download and use The COBRA Event Notification Spreadsheet you
must have Microsoft Excel on your PC.
- Employer COBRA Event Notification FAX form
FAX the completed form to 503-765-3453 - Employer COBRA
Event Notification Spreadsheet (Rev. 04/03)
Email the completed Employer COBRA Event Notification Spreadsheet to
- PEBB Agency COBRA
Event Notification Spreadsheet
Email the completed COBRA Event Notification Spreadsheet to
