Cobra Forms Now Available Through EDB

To help facilitate Cobra requests, there is a new Cobra process in EDB that is easy to use and saves time.

A Cobra form can now be printed from EDB for the following qualifying events:

  • Separation
  • Layoff
  • Retirement
  • Reduction of hours
  • Approved Leave of Absence without Pay

The current manual system, i.e. UBEN 108 and UBEN 109, must still be used for other qualifying events such as loss of eligibility due to divorce, reaching age 23, etc.

For more information, go to the "eDB" link in Related Information and click on “Information for Departmental Personnel Assistants” on the left-hand side. Navigate to "Cobra Documents and Procedures" and click on "Cobra IDOC Application Packet." On the next screen, you will see the instructions section and the two enclosures needed for the Cobra form. 

The Cobra form should be printed after the Separation Date is entered into EDB and before the Coverage End Date. 

If you have questions about this new process, contact Benefits Services.

Campus Human Resources, Benefits Services
Phone: (310) 794-0830 | Fax: (310) 794-0835