COBRA Premium Payment Instructions - Please Read, Very Important

Premium Payment Instructions for COBRA Direct Use for Regular Monthly Payments Refer to your COBRA Election Notice and Election Instructions for Complete Information

Methods of Payment Check, money order, or cashier’s check made payable to COBRA Management Services.

Means of Delivery Mail or hand deliver to us with a coupon.

How to Obtain Coupons A small supply is included with your initial packet. For additional coupons, download them from MyCOBRA > Resources or contact us by phone or email. Billing statements or invoices are not provided.

Mail your regular monthly payment and completed coupon using this exact format: COBRA Management Services PO Box 53525 Bellevue, WA 98015

When Payments are Due Monthly payment is due on the 1st of the month but no later than the end of the 30-day grace period. If payment is not “made” by the premium due date or within the grace period, your COBRA coverage will be cancelled retroactively to the last day of the month for which full premiums were received. There is no reinstatement once COBRA coverage has been terminated for non-payment.

When Payments are “Made” If mailed, payments are considered made on the postmark date.

NSF Check A NSF check does not constitute payment. It must be replaced with a cashier’s check or money order within the 30 day grace period. There is a $25 replacement processing fee.

COBRA Management Services Services Toll Free Number 1-800-750- 0213 E-mail [email protected]