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This version of the form is not currently in use and is provided for reference only. Download this version of
Form HCA50-0136
for the current year.
Form HCA50-0136 Pebb Continuation Coverage (Cobra) Election / Change - Washington
What Is Form HCA50-0136?
This is a legal form that was released by the Washington State Health Care Authority - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is the form HCA50-0136?
A: Form HCA50-0136 is the Pebb Continuation Coverage (Cobra) Election/Change form for Washington.
Q: What is Pebb Continuation Coverage?
A: Pebb Continuation Coverage is a program in Washington that allows eligible employees and their dependents to continue their health coverage after a qualifying event.
Q: Who can use Form HCA50-0136?
A: Employees and their dependents who are eligible for Pebb Continuation Coverage in Washington can use Form HCA50-0136.
Q: What is the purpose of Form HCA50-0136?
A: Form HCA50-0136 is used to elect or change Pebb Continuation Coverage (Cobra) in Washington.
Form Details:
- Released on September 1, 2021;
- The latest edition provided by the Washington State Health Care Authority;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form HCA50-0136 by clicking the link below or browse more documents and templates provided by the Washington State Health Care Authority.
Download Form HCA50-0136 Pebb Continuation Coverage (Cobra) Election / Change - Washington
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