Termination / COBRA

Service Information

Termination / COBRA

Coverage for employee health benefits ends on the last day of the month following employment termination date.  

The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows employees and/or their dependents to continue certain insurance benefits after termination of employment or when a dependent’s status changes, resulting in loss of coverage. Medical, dental and vision plans can be continued for up to 18 months under COBRA.

Payment of the full monthly cost plus an administrative fee is required. Employees have 60 days to apply for coverage retroactive to benefits termination date by submitting a completed COBRA application.

Employees are responsible for reviewing the COBRA and information regarding group benefit termination.

    Group Benefits Termination Summary

    General Notice of COBRA Continuation Coverage Rights

    COBRA Election Notice (fillable)

    2024 Monthly COBRA Rates

    Upon termination of employment with Cook County, your 457B retirement account can remain with Nationwide or you can discuss your rollover or distribution options with a Retirement Specialist at 1-855-457-2665.

    Nationwide Buyout Form

    Mail payments to:

    Department of Revenue

    118 N. Clark St., Suite 1160

    Chicago, Illinois 60602

    Please make checks payable to Cook County Department of Revenue.

    Phone payments:

    Call:  888-497-8701

    Provider ID# 58840

    Online payments:


    For payment related questions, please contact the Department of Revenue at 312-603-6961.