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Human Resources

Human Resources Administration Building
University of California, Davis
One Shields Avenue
Davis, CA 95616

(530) 752-0530 phone

 
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COBRA

The department must provide the employee with a COBRA IDOC Application Packet after processing the following types actions in PPS:
  • Termination of Employment
  • Indefinite Layoff
  • Change in BELI (Loss of eligibility)


The Benefits Office will provide the employee with a COBRA packet after receiving notification of the following actions:

  • Approved leave without pay
  • Temporary Layoff
  • Death of employee

Upon notification from the employee of one of the following events, the department must provide the employee with the UPAY 850 and the UBEN 109:

  • Divorce/legal separation/annulment
  • Termination of domestic partnership
  • Loss of dependent status

Upon receipt of the completed forms from the employee or department, the Benefits Office will provide the COBRA packet directly to the member, as indicated on the UBEN 109.

For additional information regarding family member eligibility for the UC-sponsored programs, see the following: