Federal COBRA and NYS Continuation of Coverage Premium Billing Agreement FormCobra and Nys Continuation of Coverage Premium Billing Agreement • April 10th, 2018 • New York
Contract Type FiledApril 10th, 2018 JurisdictionPlease complete this form and return the completed copy to your Account Executive or your Account Management Associate at BlueCross BlueShield of Western New York, 257 West Genesee Street, Buffalo, New York 14202.