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COBRA election form: fill out, sign and send a PDF

If your COBRA election form came as a PDF, you can fill it in, sign it and download it in your browser, then send it the way your election notice says. Companies run COBRA in different ways, so each page below covers what one company says on its own public pages.

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Federal timing, from the Department of Labor

  • The Department of Labor says that if you qualify for COBRA continuation coverage, you have at least 60 days to decide whether to enroll.
  • It says the 60-day election period begins on the later of two dates: the date the plan provides the election notice, which may be the date it is mailed, or the date you would otherwise lose coverage.
  • It also says plans must give you at least 45 days to make your first payment.

Source: U.S. Department of Labor, A Worker's Guide to Health Benefits Under COBRA (read October 27, 2026). These are federal minimums. Your election notice gives your actual dates, so follow it.

Fill out and sign a PDF election form in four steps

  1. Open the form. Drop the PDF from your election notice onto Fill and Sign PDF. If it has no fillable fields, the tool lets you type on the page.

  2. Fill it in. Type on the lines, tick the box for the choice you have made and enter only what the form asks for.

  3. Sign and date. Draw or type your signature, place it on the signature line and add the date.

  4. Download and send. Save the file with a clear name and send it the way your notice says. Keep a copy and proof of the date.

For the longer version, see our guide to how to fill out and sign a COBRA election form.

COBRA form pages by company

We add a company only when its own public pages describe how electing works. Several large names are online first, and where a company says so, its page says so first.

  • isolved COBRA form

    isolved says its continuation services manage the delivery of election notices, track eligibility, collect premium payments and give plan participants and HR teams one point of contact.

  • WEX COBRA form

    WEX's participant page offers a COBRA and direct bill login, with the line that you can access support and resources about your COBRA and direct bill account.

  • Insperity COBRA form

    Insperity says it offers COBRA participants an online administration system for electing, managing and submitting payments for their coverage.

  • Chard Snyder COBRA form

    Chard Snyder's COBRA page says you may enroll online or using the paper form provided in your COBRA Election Notice.

  • Benefit Resource COBRA form

    Benefit Resource's New to COBRA page says that after a qualifying event the employer gives the third-party administrator the required information, so the administrator can send the member paperwork and an election form, the Specific Rights Notice.

  • Ameriflex COBRA form

    Ameriflex's help article says that after a termination you receive a COBRA Election Notice, called the COBRA packet, with your rights, plan cost and how to elect coverage.

Questions about COBRA election forms

Can I fill out a COBRA election form online?

Yes, if you have the form as a PDF. Open it in Fill and Sign PDF, type your answers, sign, date and download it, then send it the way your election notice says.

Will PDFinish tell me whether to elect COBRA?

No. We help with the PDF work only. Your plan administrator can answer questions about your choices, costs and dates.

Why does each company have its own page?

Companies run COBRA differently. Some take elections online, some by a paper or PDF form. Each page reports only what that company says on its own public pages.

Is my form uploaded?

No. The form is opened and filled in your browser, and what you type stays on your device.

Sources

PDFinish is not affiliated with any company named on these pages, or with the Department of Labor. We do not host or change any company's forms.

General information, not legal, tax or insurance advice.