Cobra Ineligibility Form for Dependents - South Carolina

Cobra Ineligibility Form for Dependents is a legal document that was released by the South Carolina Public Employee Benefit Authority - a government authority operating within South Carolina.

Form Details:

• Released on April 1, 2020;
• The latest edition currently provided by the South Carolina Public Employee Benefit Authority;
• Ready to use and print;
• Easy to customize;
• Compatible with most PDF-viewing applications;
• Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the South Carolina Public Employee Benefit Authority.