Forms
The following forms are available to be downloaded to your printer. Once completed, please return them to the Office of Benefits Administration. Please note that additional documentation is often required to accompany some forms. If you do not have Adobe Acrobat on your computer, you may down-load it from the ITS Web site.
COBRA
This form is to be completed by a covered employee, spouse, or dependent to report qualifying events to the University of Southern California Office of Benefits Administration or HSC Personnel Services as required under provisions of the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Failure to complete and submit this form in a timely manner will result in a loss of health insurance continuation rights that are available under COBRA.
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