COBRA Continuation Coverage in Former Spouse’s Group Health Plan

Please choose the statement that best describes your situation:

• You were covered by the group health plan sponsored by the covered employee’s employer, employee organization (such as a union), or both on the day before your legal separation or divorce from the covered employee.
• You were not covered by the group health plan sponsored by the covered employee’s employer, employee organization (such as a union), or both on the day before your legal separation or divorce from the covered employee.