This is a legal form that was released by the Virginia Department of Human Resource Management - a government authority operating within Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.
Q: What is Form A10661?
A: Form A10661 is an Extended Coverage/Cobra Change Request form.
Q: Who is the form for?
A: The form is for participants in the Commonwealth of Virginia Health Benefits Program - Virginia.
Q: What is the purpose of the form?
A: The form is used to request changes or updates to extended coverage or COBRA benefits.
Q: What kind of changes can I request using this form?
A: You can request changes to your extended coverage or COBRA benefits, such as adding or removing dependents.
Q: Is there a deadline to submit the form?
A: It is important to submit the form within the specified timeframe provided by the Commonwealth of Virginia Health Benefits Program.
Q: Can I make changes to my benefits outside of the annual open enrollment period?
A: Yes, you can use this form to make changes to your extended coverage or COBRA benefits outside of the open enrollment period.
Q: Who should I contact if I need help filling out the form?
A: For assistance in filling out the form, you should contact the Commonwealth of Virginia Health Benefits Program - Virginia.
Q: Are there any fees associated with submitting the form?
A: Please refer to the guidelines and instructions provided by the Commonwealth of Virginia Health Benefits Program for any applicable fees.
Form Details:
Download a printable version of Form A10661 by clicking the link below or browse more documents and templates provided by the Virginia Department of Human Resource Management.