COBRA Documents and Forms

Documents and forms for City of St. Louis employees, Police Division employees and retirees interested in continuation of coverage through COBRA.

Publication Date: 01/02/2025
Document Type: Printed Forms and Templates
Sponsor: Employee Benefits

Summary
Plan information and enrollment forms for City of St. Louis employee Medical and Dental Insurance continuation of coverage through COBRA

Download

  1. pdf City COBRA Anthem Booklet 2025-2026 (4.09 MB)
  2. pdf Police Division COBRA Anthem Booklet 2025-2026 (4.08 MB)
  3. pdf Anthem COBRA Enrollment Form (700.45 KB)
  4. pdf Dental Source COBRA plan rates (261.10 KB)
  5. pdf Dental Source COBRA Enrollment Form (415.87 KB)
  6. pdf Dental Source COBRA Plan Information (509.48 KB)
  7. pdf Delta Dental COBRA Plan Documents (455.66 KB)
  8. pdf Delta Dental COBRA Enrollment Form (153.08 KB)
  9. pdf COBRA General Notice (825.93 KB)

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