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WEX COBRA form: how to fill out, sign and send it

WEX says you can elect COBRA through an online account or its COBRA mobile app, so start there if your notice gives you login details. This page is for the case where your notice came with a PDF election form instead.

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Online first. WEX describes an online account and a COBRA mobile app as the ways to get to your COBRA plan. Use the login and instructions in your notice first.

Fill and sign a PDF form

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What WEX says about electing COBRA

We did not open the COBRA forms area, so we cannot say which forms it holds. The WEX page we read does not describe a paper or PDF election form or how to send one back, so rely on the instructions in your own notice.

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 WEX election form

Use these steps only if your WEX notice came with a PDF election form and does not point you to the online account or app.

  1. Check your notice first. Look for login details or an app registration step. If you have them, WEX describes that route as available.

  2. Open the PDF form. If you have a PDF election form, drop it onto Fill and Sign PDF and type on the lines it asks for.

  3. Sign and date. Add your signature and the date, then look over the page for any line you left empty.

  4. Download and return it. Download the signed file and send it the way your notice says. If the notice names no route, ask WEX or your plan before you guess.

A made-up benefits election form with a name, a signature, a date and a box filled in, shown in PDFinish before download
A made-up sample form, not a real one and not a WEX form.

More detail is in our guide to how to fill out and sign a COBRA election form.

What to keep

  • The WEX notice or email that came with your form.
  • The signed PDF with a clear file name.
  • A screenshot or receipt that shows when and how 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 WEX COBRA form

Can I elect COBRA with WEX on my phone?

WEX says its COBRA mobile app lets you register and make an initial election, and it also lists payments in the app. Your notice tells you whether that route applies to you.

Where are the WEX COBRA forms?

WEX's participant page has a COBRA support area with a link named Access COBRA forms. We did not open it, so use the form your notice names.

Is Chard Snyder part of WEX?

Chard Snyder describes itself as a WEX company. We have a separate page on what Chard Snyder says about electing.

Does WEX say how to send back a paper election form?

The WEX page we read does not. Follow your notice, and keep a record of when you sent the form.

More COBRA form pages

Sources

PDFinish is not affiliated with WEX. We describe what WEX says on its own public pages, and we do not host or change its forms.

General information, not legal, tax or insurance advice.