Ameriflex COBRA form: how to fill out, sign and send it
Ameriflex says that once your COBRA election packet is printed and mailed, you can elect through its COBRA online portal or by US mail. If you are electing by mail and your form is a PDF, fill it in and sign it here.
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Online first. Ameriflex names its COBRA online portal as one way to elect, next to US mail. Check your packet for the portal details.
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What Ameriflex says about electing COBRA
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.
Source: Ameriflex help center, What is COBRA? (New Platform) (read October 27, 2026)
It says the packet also gives information on getting coverage through the Marketplace, a private plan, a spouse's plan or a new employer's plan.
Source: Ameriflex help center, What is COBRA? (New Platform) (read October 27, 2026)
It says that once the election packet is printed and mailed, you can elect through the COBRA online portal or US mail.
Source: Ameriflex help center, What is COBRA? (New Platform) (read October 27, 2026)
It says that once your election and first payment are received, Ameriflex sends a notice to reinstate your coverage, and that the insurance carrier may take longer to process it.
Source: Ameriflex help center, What is COBRA? (New Platform) (read October 27, 2026)
The article tells readers to see their enrollment materials or the Department of Labor's COBRA FAQs for more information, and its page shows an updated date of about a year before we read it.
Source: Ameriflex help center, What is COBRA? (New Platform) (read October 27, 2026)
The page does not name the election form or say whether it is a PDF, and it does not give a mailing method beyond US mail. Use the form and instructions in your own packet.
Your election notice has your own address, phone numbers and dates. We do not list them, so use the ones in your notice.
Fill out and sign a PDF Ameriflex election form
These steps apply when you are electing by mail and your Ameriflex election form is a PDF.
Open your packet. Find the election form in the COBRA packet Ameriflex describes and drop it onto Fill and Sign PDF.
Type your choices. Fill in the lines and mark the options you choose. Enter only what the form asks for.
Sign and date. Add your signature and the date. Your packet says what a mailed election must include, so read it before you send.
Download and send by mail. Print the signed PDF if mail is your route, or send the file if your packet allows it. Keep proof of the date.
More detail is in our guide to how to fill out and sign a COBRA election form.
What to keep
- The Ameriflex election packet.
- The signed PDF, and a photo of the printed copy if you mail one.
- A mail receipt or tracking number that shows the date you sent it.
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). Your election notice has your actual dates.
Questions about the Ameriflex COBRA form
How does Ameriflex say I can elect COBRA?
Its help article says that once the election packet is printed and mailed, you can elect through the COBRA online portal or by US mail.
What is in the Ameriflex COBRA packet?
The article describes a COBRA Election Notice with your rights, plan cost and how to elect, plus information on other coverage such as the Marketplace.
Does Ameriflex name the election form?
The article we read does not name the form or say it is a PDF. Use the form that came in your own packet.
Is the Ameriflex help article current?
The page shows an updated date of about a year before we read it on the date below. For current steps, follow your packet and ask Ameriflex.
More COBRA form pages
Sources
- Ameriflex help center, What is COBRA? (New Platform): myameriflex.crunch.help/en/new-cobra-platform/what-is-cobra-new-platform (read October 27, 2026)
- U.S. Department of Labor, A Worker's Guide to Health Benefits Under COBRA: dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/publications/workers-guide-health-benefits-cobra (read October 27, 2026)
PDFinish is not affiliated with Ameriflex. We describe what Ameriflex says on its own public pages, and we do not host or change its forms.
General information, not legal, tax or insurance advice.