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How to Fax a COBRA Election Form

Updated October 2026

Your job ended, a COBRA election notice arrived, and you want to keep your health coverage. You can fax the signed election form for $1.00, but only to the fax number printed on your election notice.

There is no official national COBRA fax number. Every plan has its own administrator. This guide covers where to find the right number, how long you have, and what to put on each page.

Quick answer: Fax the COBRA election form to the fax number listed on your election notice, which names your plan's COBRA administrator. The plan must give you at least 60 days to elect, counted from when coverage ends or the notice arrives, whichever is later, and at least 45 days after electing to make the first premium payment. It costs $1.00 for up to 10 pages.

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In this guide

Where to Fax Your COBRA Election Form

Your election notice names the plan's COBRA administrator and tells you where to send the election form: an address, a fax number, or both. Use only the fax number on that notice. If the notice gives only a mailing address, call the administrator at the phone number on the notice and ask whether they accept the election by fax, and at what number.

Do not use a fax number from a search result or an old letter. COBRA is often run by an outside administrator, not your former employer's HR office, and a fax sent to the wrong place may never reach the people who process elections. If you are not sure, call and confirm the number before you send.

The 60-Day Election and 45-Day Payment Deadlines

The Department of Labor's guide to COBRA sets two clocks:

Your notice states the exact dates for your plan. Read them there and mark them on a calendar. Electing early does not mean you have to pay early; the 45 days start when you elect. Pay the premium the way your notice tells you to.

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What to Put on the Cover Page and Each Page

The cover page should say: "COBRA election form," the plan name from the notice, the covered employee's full name, any ID or reference number printed on the notice, your phone number, and the page count. If you are electing for family members too, list their names.

Write the employee's name and the notice reference number at the top of each page. Sign and date the election form where it asks before you scan it. It can help to include the notice page that shows the plan name, so the administrator can match it quickly.

A cover page, the election form and a page or two of the notice is usually well under 10 pages, so it costs $1.00. Up to 10 pages is $1.00, 11 to 25 pages is $1.99, and 26 to 50 pages is $2.99.

How to Send It for $1.00

  1. Sign and date the election form. Scan or photograph it into one PDF with your cover page.
  2. Go to FaxForADollar.com and upload the file.
  3. Type the 10-digit fax number from your election notice, area code first. The +1 is already added, so do not type a leading 1.
  4. Pay $1.00. No account and nothing to cancel.

It is usually delivered within a few minutes. Nothing is printed on your document. You get a confirmation email with the destination number, page count and time (Eastern Time). That email is your record of exactly when you sent your election; keep it with the notice. If the fax fails, the money goes back to your card automatically and you can send again right away.

If the administrator wants to fax you a confirmation or a question, our sister service GetAFax.com gives you a US fax number for 24 hours for $5, up to 30 pages, with faxes arriving in your email.

Send a fax now, $1.00

COBRA is rarely the only form on the table. If you are eligible for Medicare and coming off an employer plan, read our Medicare Part B guide before you decide, since Part B has its own 8-month enrollment window. For unemployment benefits, see our state unemployment office guide. For a 401(k) or pension rollover, see our retirement plan forms guide.

If you were on medical leave before the job ended, our FMLA certification guide covers sending that paperwork to HR. To fax any of these from a phone, see our iPhone guide or Android guide.

Before You Hit Send

Check three things. The fax number matches the one on your election notice, digit for digit. Every page that needs a signature is signed and dated. Every person you want covered is listed on the form.

Then send it, and keep your copy and the confirmation email together. If you hear nothing back, call the administrator, give them the date and time from your confirmation email, and ask them to confirm they have your election on file.

Why send it here

One dollar for up to 10 pages to any US or Canada number, shown before you pay, nothing added at checkout.

Nothing is printed on your document. It arrives exactly as you uploaded it.

If it cannot be delivered, the money goes back to your card without you asking.

No account, no subscription, nothing that renews. Send once and you are done.

Frequently Asked Questions

Cost and what you get
How much does it cost to fax a COBRA election form?
$1.00 for up to 10 pages to any US fax number. Pages 11 to 25 are $1.99 and 26 to 50 are $2.99. No account and no subscription.
Does the $1.00 include my COBRA premium?
No. The $1.00 only pays for sending the fax. You pay the COBRA premium to the plan the way your election notice tells you to.
Sending a fax
Can I fax my COBRA election form?
Yes, if your election notice lists a fax number. Send it only to the fax number or address on that notice.
got laid off and my COBRA notice came in the mail, can I fax the election form today?
Yes. Sign it, scan it, and fax it to the number on the notice for $1.00. It usually arrives within a few minutes and you get a confirmation email with the time it was sent.
Who do I send my COBRA election form to, my old employer or the COBRA administrator?
Whoever your election notice names. The notice names the plan's COBRA administrator and the address or fax number to use.
My COBRA notice only has a mailing address, can I still fax the election?
Call the administrator at the number on the notice and ask whether they accept it by fax and at what number. Do not guess a fax number.
Fax numbers and format
What is the fax number for COBRA?
There is no official COBRA fax number. Use only the fax number printed on your election notice.
Do I add a 1 before the COBRA administrator fax number?
No. Type the 10-digit number with the area code. The +1 is already added.
What should the cover page say on a COBRA election fax?
"COBRA election form," the plan name, the employee's full name, the reference number from the notice, your phone number and the page count.
Should I fax my COBRA election notice along with the form?
Sending the notice page that shows the plan name and your reference number helps the administrator match your election. Follow any instructions on the notice itself.
Receiving a reply
Can the COBRA administrator fax me a confirmation?
Yes, if you give them a fax number. Our sister service GetAFax.com gives you a US fax number for 24 hours for $5, up to 30 pages, sent to your email.
Delivery, proof and safety
How do I show I sent my COBRA election on time?
Keep the confirmation email. It shows the destination number, page count and time in Eastern Time, your record of exactly when it was sent.
What if my COBRA election fax fails?
You get your money back automatically and an email saying it did not go through. Check the number and send it again right away.
Will my COBRA form show an ad or a stamp when it arrives?
No. Nothing is printed on your document. The administrator receives it exactly as you uploaded it.
More questions
How long do I have to elect COBRA?
At least 60 days, counted from when your coverage ends or when you get the election notice, whichever is later. Your notice gives your exact date.
When is my first COBRA premium due after I fax the election?
The plan must give you at least 45 days after you elect to make the first premium payment. Check your notice for the exact date.
Can I fax my COBRA election and pay the premium later?
Yes. You elect first, then you have at least 45 days after electing to make the initial premium payment.
Can I fax a COBRA election form from my phone?
Yes. Photograph or scan the signed form, upload it on FaxForADollar.com, enter the number from your notice and pay $1.00. No app or account needed.
Can my spouse fax the COBRA election form for our family?
Anyone can send the fax. Make sure the form is signed where it asks and every family member you want covered is listed.
I am eligible for Medicare, should I fax a COBRA election form or sign up for Part B?
Read both deadlines before you decide. Our Medicare Part B guide covers the CMS-40B, the CMS-L564 and the 8-month Special Enrollment Period.

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