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
This page provides information and enrollment forms for City of St. Louis employee Medical and Dental Insurance continuation of coverage through COBRA.

For more information on COBRA please contact the Department of Personnel Employee Benefits Section at CityEmployeeBenefits@stlouis-mo.gov

Download

  1. pdf COBRA Anthem Booklet 2025-2026 - City (4.09 MB)
  2. pdf COBRA Anthem Booklet 2025-2026 - Police (4.08 MB)
  3. pdf COBRA Anthem Enrollment Form - City (463.54 KB)
  4. pdf COBRA Anthem Enrollment Form - Police (60.38 KB)
  5. pdf COBRA Delta Dental Plan Documents (455.66 KB)
  6. pdf COBRA Delta Dental Enrollment Form - City (407.15 KB)
  7. pdf COBRA Delta Dental Enrollment Form - Police (407.15 KB)
  8. pdf COBRA Dental Source Plan Information (509.48 KB)
  9. pdf COBRA Dental Source Enrollment Form (287.46 KB)
  10. pdf COBRA Rates 2025-2026 - City (171.52 KB)
  11. pdf COBRA Rates 2025-2026 - Police (169.15 KB)
  12. pdf COBRA General Notice (825.93 KB)

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