Common use of COBRA Coverage Clause in Contracts

COBRA Coverage. Domestic partners are not considered "qualified beneficiaries" under federal COBRA regulations but are eligible for COBRA-like continuation coverage if offered and provided by the insurance carrier(s), and under the terms and conditions of the insurance carrier(s). As such, the District retains the right to modify or terminate this continuation of coverage benefit at any time. Form: Affidavit of Domestic Partnership Form: Declaration of Termination of Domestic Partnership (stored as PDF files; you need Acrobat Reader to access the forms; if you do not have Acrobat Reader, click this icon to download it) Access the Affidavit of Domestic Partnership Access the Declaration of Termination APPENDIX F GRIEVANCE FORM

COBRA Coverage. Domestic partners are not considered "qualified beneficiaries" under federal COBRA regulations but are eligible for COBRA-like continuation coverage if offered and provided by the insurance carrier(s), and under the terms and conditions of the insurance carrier(s). As such, the District retains the right to modify or terminate this continuation of coverage benefit at any time. Form: Affidavit of Domestic Partnership Form: Declaration of Termination of Domestic Partnership (stored as PDF files; you need Acrobat Reader to access the forms; if you do not have Acrobat Reader, click this icon to download it) Access the Affidavit of Domestic Partnership Access the Declaration of Termination APPENDIX F GRIEVANCE FORMG NONDISCRIMINATION AND DIVERSITY

COBRA Coverage. Domestic partners are not considered "qualified beneficiaries" under federal COBRA regulations but are eligible for COBRA-like continuation coverage if offered and provided by the insurance carrier(s), and under the terms and conditions of the insurance carrier(s). As such, the District retains the right to modify or terminate this continuation of coverage benefit at any time. Form: Affidavit of Domestic Partnership Form: Declaration of Termination of Domestic Partnership (stored as PDF files; you need Acrobat Reader to access the forms; if you do not have Acrobat Reader, click this icon to download it) Access the Affidavit of Domestic Partnership Access the Declaration of Termination APPENDIX F GRIEVANCE FORMG Nondiscrimination and Diversity

COBRA Coverage. Domestic partners are not considered "“qualified beneficiaries" ” under federal COBRA regulations but are eligible for COBRA-like continuation coverage if offered and provided by the insurance carrier(s), and under the terms and conditions of the insurance carrier(s). As such, the District retains the right to modify or terminate this continuation of coverage benefit at any time. Form: Affidavit of Domestic Partnership Form: Declaration of Termination of Domestic Partnership (stored as PDF files; you need Acrobat Reader to access the forms; if you do not have Acrobat Reader, click this icon to download it) Access the Affidavit of Domestic Partnership Access the Declaration of Termination APPENDIX F GRIEVANCE FORMG NONDISCRIMINATION AND DIVERSITY

COBRA Coverage. Domestic partners are not considered "“qualified beneficiaries" ” under federal COBRA regulations but are eligible for COBRA-like continuation coverage if offered and provided by the insurance carrier(s), and under the terms and conditions of the insurance carrier(s). As such, the District retains the right to modify or terminate this continuation of coverage benefit at any time. Form: Affidavit of Domestic Partnership Form: Declaration of Termination of Domestic Partnership (stored as PDF files; you need Acrobat Reader to access the forms; if you do not have Acrobat Reader, click this icon to download it) Access the Affidavit of Domestic Partnership Access the Declaration of Termination APPENDIX F GRIEVANCE FORMAppendix G Nondiscrimination and Diversity

COBRA Coverage. Domestic partners are not considered "qualified beneficiaries" under federal COBRA regulations but are eligible for COBRA-like continuation coverage if offered and provided by the insurance carrier(s), and under the terms and conditions of the insurance carrier(s). As such, the District retains the right to modify or terminate this continuation of coverage benefit at any time. Form: Affidavit of Domestic Partnership Form: Declaration of Termination of Domestic Partnership (stored as PDF files; you need Acrobat Reader to access the forms; if you do not have Acrobat Reader, click this icon to download it) Access the Affidavit of Domestic Partnership Access the Declaration of Termination APPENDIX F GRIEVANCE FORMFORM Instructions: Sections 1 through 9 must be completed by the grievant (please type or print). One copy of this form must be submitted to the respondent. The appropriate grievance procedure for your respective unit must be followed.