Under the Public Health Service Act, as amended, covered Employees and their covered Dependents
may have the right to continue coverage beyond the time coverage would ordinarily have ended. Only
covered Employees, their covered spouses and covered Dependent Children and the covered
spouses and Dependent Children of covered Retirees are qualified beneficiaries.

The Plan Administrator is the Office of the Commissioner of Higher Education, 2500 Broadway, Helena, MT 59601; 406-444-2574. COBRA continuation coverage for the Dental Plan and the Vision Hardware Plan is administered by Allegiance COBRA Services, Inc.; P.O. Box 2097; Missoula, MT 59806, 406-721-2222. Blue Cross and Blue Shield of Montana continues to process vision hardware claims. Delta Dental continues to process dental claims. COBRA continuation coverage for Medical Plans is administered by the Claims Administrators for those plans.

COBRA continuation coverage is available to any qualified beneficiary whose coverage would otherwise
terminate due to any qualifying event. COBRA continuation coverage under this provision will begin on
the first day immediately following the date coverage terminates.

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Cobra Enrollment Form





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Montana University System • Office of the Commissioner of Higher Education
2500 Broadway Street • PO Box 203201 • Helena, MT 59620-3201 • 406-444-6570

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