COBRA Premium Assist Payments Table

Fields on the COBRA Premium Assist Payments Table

Code. Enter a Code (required) of ten characters or less with no spaces or special characters. Each code must be unique.
Description. Enter a brief description of less than thirty characters, with no special characters or punctuation.
Company Code. Select the company that this payment applies to.
Payment Date. Choose the date that the payment was made. The payment date determines which quarter this applies to.
Payment Amount. Enter the amount of the COBRA premium assistance payment.
Employees Assisted. Enter the number of employees assisted by this payment.