Common Contracts

Federal COBRA and NYS Continuation of Coverage Premium Billing Agreement Form

Billing Agreement • April 10th, 2018 • New York

• Contract Type
  Billing Agreement
• Filed
  April 10th, 2018
• Jurisdiction
  New York

Please 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.