Carrier Enrollment Forms
The below information will provide Qualified Beneficiaries (QBs) with the necessary carrier enrollments forms (such as medical, RX, dental, or vision) that may required to complete your COBRA reinstatement. Please click the “download now” button next to applicable carrier and return the completed enrollment form with your COBRA election paperwork. Should you have any questions, please contact OCA directly at 855-622-0777 or email cobra@oca125.com.