COBRA Renewal

Complete the below to renew your COBRA plan.
Complete the COBRA Renewal Kit and submit it below*
The COBRA Renewal Kit is accessible through a link in the renewal reminder email.
Drop files here or

Max. file size: 100 MB.
Enter your name below to acknowledge that you are renewing with Admin America, Inc and the information you have submitted is accurate. Inaccurate information submitted to Admin America, Inc. that results in reprocessing will incur a reprocessing fee of $20.00 per packet. Reprocessing that results in an audit will incur an audit fee of $150.00 per audit hour.*
Date*
MM slash DD slash YYYY

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